| Name: |
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| Street Address: |
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| City: |
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| State/Province: |
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| Zip/Postal Code: |
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| Country: |
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| Phone: |
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| Fax (optional): |
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| Email: |
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| Occupation: |
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| Age: |
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| Gender: |
M:
F:
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| Annual Household Income: |
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Hobbies:Hold down "Control (ctrl)"
to select multiple hobbies |
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| Approximate Lot Size: |
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| Length of time at Residence: |
Years |
| Approximate House Value: |
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| Rate your interest in gardening: |
(1=Low 10=High) |
| Pond Information |
| Is this your: |
First Pond
Second Pond
Replacement Pond
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| Does your pond include: |
Waterfall
Stream
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| Pond dimensions in feet please |
| Pond Length: |
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| Pond Width: |
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| Pond Max Depth: |
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| Pond Average Depth: |
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| Pond Gallons: |
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| Price of installed pond: |
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| Where is pond located in yard: |
Front
Back
Side
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Amount of money spent on fish, rocks, water, plants,
ornamentation, etc |
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| Are there rocks and gravel in your pond? |
Yes
No
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| Liner (what kind), preformed, concrete, EPDM... |
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| Did you spend more money than you initially budgeted for? |
Yes
No
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| Is the pond larger,smaller or the size initially intended? |
Larger
Smaller
Correct
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| Do you wish the pond was larger, smaller or is it correct? |
Larger
Smaller
Correct
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| Where did you purchase your product? |
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| City/State/Zip |
City
State
Zip
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| Model Numbers on your Products: |
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| Installer
Information |
| How was your pond installed: |
Myself
Professionally
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If you installed the pond yourself,
what did you use for directions: |
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| If Professionally, Name of Contractor: |
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| City/State/Zip |
City
State
Zip
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| How did you hear of them: |
Referral
Saw Vehicle
Phonebook
Homeshow
Flyer
Other
Brochure
Door Hanger
Mailing
Internet
Aquascape
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Please rate the overall
skill level of the installer: |
(1=Low 10=High) |
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Yes! I would like to be contacted with more information on new
products, free products and specials. |
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Yes! I would like to receive your monthly newsletter. |
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