Rainsoft And Discovery Marketing and Distributing, Inc. Florida

How does your water rate? Do you know if any contaminants or chemicals exist in the water you drink and use…impurities which can pose a health risk to you and your family.

Now’s the time to get the clear facts about the safety and quality of your water.

Discovery Marketing & Distributing, Inc. is not affiliated with city water or county health departments.

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First Name*
Middle Initial
Last Name*
Company
Residential Commercial
Address*
City*
State*
Postal Code*
Country*
Phone*
Alt Phone
Best time to call
Fax
E-mail*
1. What type of residence do you have?
Home Townhome Condo
Apartment Other
2. How many people live in your residence?
3. Please indicate your age bracket?
18-25 36-45 56-65
26-35 46-55 65 and older
4. How do you receive your water?
Municipal (city) Private Well
5. Check all the conditions you have experienced with your water:
Bad taste Bad smell Cloudiness Spotted dishes/glasses Build-up on fixture/shower heads Dry skin / Dry scalp
6. Do you currently have a water treatment system? Yes No
If "yes" . . . Rent Own RainSoft Other
7. Do you currently have a water filter system?
Yes No
If "yes", check all that apply Whole-house Under the sink Single tap Faucet mounted
8. Do you use bottled water? Yes No
If "yes", where do you purchase your bottled water? Grocery/General Merchandise Store Home Delivered (name)
9. Additional comments