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Free Water Analysis

Please fill-in the information below.  Items required are indicated by an asterisk.  We appreciate this opportunity to serve you.   We will contact you on the same or next business day to arrange your no-cost, no-obligation water anaysis.

Name*
Address*
City*
State*
Zip*
Phone*
Email*


Number of people living in the home?


What type of water supply do you have?
Municipal(city)
Private Well


Please check the boxes that apply to you:

Spotty dishes/glassware Pinhole leaks in pipes
Scale build-up on fixtures/shower heads Shortened hot water heater life
Dry skin/scalp conditions Rust or "blue-green"stains
Bad taste/odor (chlorine, rotten egg, metallic) Are you concerned about lead in your water?
Other   

Do you have a water softening system? Yes No

If "yes" (check one)

Rent Own


What type? (check one)

Culligan
Other


Are you currently using a filter system? Yes No

If "yes" what type (check all that apply)

Whole house Under-the-sink
Single tap Faucet mounted


Do you use bottled water?
Yes No

If "yes" where do you get it from?

Supermarket
Home delivery (name)


Additional comments:

 

 

 
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