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Water Quality Survey
November 9, 2016
Water Quality Survey
1. Do you notice any bad taste or odors in your water?
(Required)
Yes
No
2. Do you notice a raw water film or spotting from the water?
(Required)
Yes
No
3. Are your fixtures corroding?
(Required)
Yes
No
4. Does anyone in your home have dry or irritated skin?
(Required)
Yes
No
5. Are minor children using the raw water?
(Required)
Yes
No
6. Do you have a water softener?
(Required)
Yes
No
7. Do you own your home?
(Required)
Yes
No
8. Do you purchase bottled water?
(Required)
Yes
No
Delivered?
(Required)
Yes
No
I would like a FREE water analysis!
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
ZIP Code
(Required)
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877-224-8444
