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    Safety Cover Repair & Replacement Program RA Form

    STEP 1: CUSTOMER INFO AND POOL LOCATION
    Name: *
    Phone: *
    Address: *
    Email: *
    City: *
    State: *
    Zip: *
    STEP 2: TYPE OF WORK TO BE PERFORMED *
    Additional Comments:
    STEP 3: POOL SIZE
    Overall length (at largest point):
    Overall Width (at widest point):
    Shape:

    Note: Old covers can shrink or stretch over time. It is very important to provide overall length and width of pool to help us determine shrink factor of your old cover

    STEP 4: INFORMATION ABOUT EXISTING (OLD) COVER BEING RETURNED
    Cover Size:
    Cover Shape:
    Color:
    Material Type:
    Manufacturer of Old Cover:
    Manufacturer of Old Cover:
    Serial Number: