Your Name (required)

Your Phone Number (area code, no dashes)

Address of Pond (required)

Town (required)

Zipcode (required)

I prefer my pond to be cleaned on (Pick day or put "ASAP"): (required)

I prefer my cleaning time to be at or close to (we start at 7:45am): (required)

I have approximately this many fish: (required)

I would guess my fish are about this size: (required)

Use my credit card for my deposit and send me the receipt.
My deposit amount you are to charge on my card is ($):

Credit card Number:

Card Type:
MastercardVisaDiscover

My card expires:

Last 3 numbers on back of card (cvv code):

Your Email (required)

*By typing your name here you are electronically signing this form and authorize K and A Ponds to charge the amount listed above to the credit card listed above.

Signature (Type name) (required)