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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