EmailMe Form - Silver Package

Customer Information

Name *

First Last

Service Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Please enter the address that receives the irrigation services.

Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Please enter the address that is on file with the credit card.

Phone Number *

### - ### - ####

Email *

Appointment Information

Please tell us any special instructions, service needs or site notes?

For example, if your controller is inside your home, we will need access. Please tell us any special instructions, service needs or site notes.

Who is your Water Utility Company?

Preferred Date of First Service

MM / DD / YYYY

Alternate Preferred Date of First Service

MM / DD / YYYY

Preferred Time of Day for Service

Payment Information

Once the prepay is made, you will automatically be signed up for our AutoPay feature. The AutoPay feature ensures continuation of service until you choose to cancel, with no need to keep track of renewal dates. Rainscapes will automatically renew your subscription using the payment method on file until you cancel.

Name on the Account

Name on the Credit Card

Authorization of Charges *

I Agree to the Service Agreement

As the named cardholder, I authorize Rainscapes to immediately charge my credit card the above amount for the Seasonal Irrigation Package listed above.

Referral Name (optional)

Next Steps for Auto Renewal

Please fill out the information on the next page using the credit card you would like to assign for auto renewal. PLEASE NOTE: Your card will not be charged twice.