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Copyright 2005 by THE PIER PLACE OF ANGOLA, INC.
All Rights Reserved.
Please fill out the form below to schedule your SPRING service.
Name
*
Name of Lake
*
Lake Address
*
Home Billing Address
*
Home Phone
*
Cell Phone
Email Address
Install Pier Spring 2010
*
Yes
No
Install Boatlift Spring 2010
*
Yes
No
Install Personal Watercraft Lift Spring 2010
*
Yes
No
Would you like a Pier Place Representative to call you?
*
Yes
No
Lastest Date These Services Can Be Preformed
Special Instructions
Please type your name below as your online signature.
Customer Signature
*
We accept Mastercard, Visa and Discover credit cards. If you choose to pay with a credit card please fill in below. This is sercure and confidential.
Card#
Exp. Date
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