Home Water Quality Assessment

1

Have you noticed any of the following with your water?* This field is required.Select all that apply.

Chlorine smell / rotten egg smell

Metallic taste

Water spots on dishes

Cloudy or discolored water

Dry skin or hair

None

2

Which of these sounds most like your home?Select all that apply.

We drink tap water regularly

We mostly use filtered or bottled water

We deal with hard water buildup

Our water has taste or odor issues

We’re tired of replacing filters everywhere

Just exploring options

We’ve been thinking about a whole home solution

3

How many people are in your household?* This field is required.Select One

1 - 2 People (120 - 200 gal/day)

3 - 5 People (200 - 500 gal/day)

5+ People (500+ gal/day)

4

Do you currently use any type of water filtration?* This field is required.Select all that apply.

No

Yes - Whole Home

Yes - Under the Sink

Yes - Shower

Yes - We use a lot of bottled water

Other

5

What type of home do you have?* This field is required.

Single family

Town Home

Condo

Other

6

Have you ever had your home's water professionally tested?* This field is required.

Yes

No

7

What's your zip code?

8

What’s your name?* This field is required.

First Name

Last Name

9

What’s your email address?* This field is required.

example@example.com

10

What’s the best phone number to reach you?* This field is required.We will call you to discuss the results of your assessment along with pricing options.

Please enter a valid phone number.