1. Please select your areas of concern:
Hardness/Calcium Deposits
Bacteria
Iron/Orange Staining
Foul Odor
Sediment
Other (please specify below)
If Other, please specify:
2. Please select any equipment in which you're interested:
Water Softeners
RO Drinking Water Systems
Ultra-Violet Sterilizers
Filters
Chlorination Systems
Neutralizers
Other (please specify below)
If Other, please specify:
3. Do you buy bottled water?
Yes
No
4. Do you currently have a whole-house water softener or conditioner?
Yes
No
5. Has your water been tested?
Yes
No
6. Do you:
Own or
Rent?
7. Is the property in question
Commercial or
Residential?
8. Enter specific comments or questions in the following field:
9. Tell us how to get in touch with you ( * fields are required):
First Name*
Last Name*
Company
Address*
City/Town*
State*
Zip*
E-mail*
Tel*
FAX
Please contact me as soon as possible regarding this information.
