Treatment Request Form

Name(Required)

First Last

Phone

Email(Required)

Lake name

County

Total shoreline (feet)

Program interests

Check all that apply.

Lake weed control

Swimmer's itch treatments

Muck reduction

Emergent vegetation treatments (cattails, reeds, water lilies)

Treatment address(Required)

Street Address Address Line 2 City State ZIP Code

Billing address

Same as treatment address

Street Address Address Line 2 City State ZIP Code

Comments

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