Free Water Consultation | Pure Life with Windy

FREE WATER CONSULTATION

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Full Name *

Email *

Phone *

Postal code *

What is the Best Day & Time for Us to Connect? *

What Concerns Do You Currently Have About Your Tap Water's Quality or Taste? *

Have You Noticed Any Sediment, Discoloration or Unusual Taste in Your Tap Water Recently? *

Are You Aware of Any Water Quality Reports or Issues in Your Local Area? *

Have You Received a Boil Alert? *

Yes

No

I don't know

Have You or Your Family Members Experienced Any Health Issues That You Believe Could Be Related to Water Quality? *

Are You Interested in Learning How Purified, Mineralized Water Can Enhance Your Health & Well-being? *

Yes

No

How Many Cases of Bottled Water Do You Purchase Each Month? *

0-5

5-10

10+

Do You Purchase Organic Produce? *

Yes

No

Sometimes

How Many People Live in Your Home? *

How Many Bathrooms Are in Your Home? *

Are You a Home Owner *

Yes

No

In the Process of Buying

Would You Like a Free Water Report About the Contaminants in Your Water? If Yes, Please Provide the Name of Your Water Provider (Usually Found on Your Monthly Statement) *

If You Were Referred by Anyone, Type Thier Name Below. *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.