Suburban Lawn-Plant Problem Diagnosis Checklist

SuburbanLawn
Nursery & Landscaping

Warranty Replacement Form

Date:

Invoice Document Number:

Invoice Date:

First Name:

Last Name:

Home Phone:

Work Phone:

Address:

City:

Zip Code:

Email:

Do you regularly use email?
Yes or No

Fill in the quantity and type of plant with a problem. The location it is in relation to the house and the direction it is facing (N,E,W,S).
Plant Quantity:
Location:
Fill in the symptoms that apply to your plant. Add any additional information at the end.
Leaf Color?	Yellow Light green Brown
Leaves affected?	Few orMany? New orOld? Whole leaf or Spots? Center or Edges?
Branches affected?	High Low Scattered or All? All sides or One side?
Sap dripping?	Yes or No
Wounds?	Base of plant or Higher? Which side? % of circumference
Trunk?	Small holes present? Yes or No Sap dripping? or No Loose Bark? Yes or No Cracks? Yes or No
Flowers?	Fail to bloom? Yes or No Undersized? Yes or No
Please enter additional notes about the plant here: No additional notes
Please fill in all of the following questions regarding your routine lawn maintenance.
Watering program:	Never Only during dry periods Once/month Once/week Once/day
Do you use a lawn service?	Yes or No
Has your property been sprayed for insects in the last month?	Yes or No
If yes: for what kind of insect?

We appreciate your business. Therefore, we will send one of our representatives out to the plant site as soon as possible to begin processing your service request. Thank you for your patience.

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Cindy McDonnell © 1999	Last updated October 21, 1999