Spring Service Payment Form Billing InformationName:* First Last Address:* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:*Email:* Spring Water Feature Service***Note: If you are a VIP customer, please fill out the VIP Spring Service Payment Form!!!Main Service Type (please select 1):*Clean out my ENTIRE pond & all filters ($795)ONLY clean my skimmer and biofalls ($450)* If your pond requires more than 6 man hours you will be assessed an additional charge at the rate of $75/man hour.Products & PlantsLotus Price: $175.00 Quantity: Tropical Water Lilies Price: $145.00 Quantity: Hardy Water Lilies Price: $95.00 Quantity: Iris or Dwarf Umbrella Palm Price: $25.00 Quantity: Other Marginals (Pondscapes of Charlotte selection) Price: $25.00 Quantity: Divide and re-pot lilies - $90 per plant (Pondscapes of Charlotte highly recommends) Price: $90.00 Quantity: AerationLarge Aerator Price: $665.00 Quantity: Small Aerator Price: $299.00 Quantity: LightsLED Light Fixture Price: $300.00 Quantity: Transformer 60-150 watts Price: $195.00 Quantity: Vista or Kichler Transformer (lifetime warranty) Price: $435.00 Quantity: Algae ControlIonizer Price: $995.00 Quantity: Replace Ionizer Probe Price: $195.00 Quantity: Although we take extra care to keep your fish safe and free of harm during your ponds clean out, we cannot guarantee their health or safety. In spring the immune systems of your fish are at their weakest and they are most vulnerable to disease, stress, injury or other physical illnesses, even death. Therefore Pondscapes of Charlotte LLC does not, at any time, take responsibility for the health or safety of your fish and will not be held liable or negligible for the health, safety or physical well-being of your fish.Coupon Code: (enter spring5 here if paying before 3/1/17) If you have a coupon code, please enter in the code and click apply.Total Amount: $0.00 Notes:If you have any notes or comments you would like to include, please enter them here. Credit Card Information:* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name Agree & Proceed By checking the box indicated, I am acknowledging that I accept and agree to abide by the terms and conditions as outlined EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.