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.

Sign up below for our FREE Professional Water Analysis and we’ll schedule a convenient appointment with you.

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

 

(* required)

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
   

            

 

 

 

 

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