On-line Appointments Page

On-line Appointments

Please use the appointment form below to set up a day and time for your free water test.

You can now set up an appointment or order supplies on-line 24 hours a day by simply filling in this form. The appropriate person will contact you to schedule your appointment as close to the date and time you have selected as possible. If you are ordering supplies such as salt or water, we will do our best to fill your order on the route truck going out on the day you have selected.

Remember, you can always reach us by phone during business hours at 1.218.327.1144 or 1.800.642.4011. We will be glad to set up an appointment or assist you in any way we can.

* All fields are required & cookies must be enabled on your computer.

Are You Currently Our Customer:

* Yes No

First Name:

Last Name:

Address:

City:

State:

Zip:

Phone:

*- [area code] - [number]

2nd Phone:

- [area code] - [number]

Email:

Appointment Time:

Appointment For:

I am interested in: Residential Products Commercial Products

Your water supply is from? Municipal (city) Private Well

Please check the boxes that apply to you:

	Spotty dishes/glassware	Scale build-up on fixtures
	Blue-green stains	Shortened hot water heater life
	Dry Skin/scalp	Rust or Black Stains
	Bad Taste/odor	Cloudy water
	I am concerned about lead in my water

Please check the water treatment devices you currently use:

Water softener	Whole house filter
Under-the-sink filter	Water pitcher filter
Faucet mounted filter	Other
None

Select the type of bottled water you currently use:

Single serve bottles	Delivered 5 Gallon
Other	None

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