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Purified Water and Air Products.com
WATER PURIFICATION
Alkalizing Water Filter
Doulton Water Filters
Doulton Replacement Filters
Crown Water Filters
CWR's Virtual Reverse Osmosis
Imperial Replacement Filters
Shower Filters
CWR'S Bathtub Filter
High Output Shower Filter & Massager
Whole House Systems
Kwik Connect Reverse Osmosis
5 Stage Reverse Osmosis
Travel & Emergency Filters
Power Sports Bottle
Stainless Steel Water Bottles
2 Temp. Water Cooler w/RO Unit
Water Quality FAQs
Water Filter Parts
Touch Free Restroom
Testing Kits
AIR PURIFICATION
Portable Air Filters
Mini-Mate
VIRA-MASK N-99
FIT-SEAL
Air Purifier Replacement Parts
CARE Replacements
Air Quality FAQs
WARRANTY REGISTRATION
Newsletters, Articles
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Questions
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Verify
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Receipt
Please completely fill out the form so we can design a system that will be the most effective to reduce your water contamination.
First Name*
Last Name*
Company
Address*
City*
State*
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Arizona
Arkansas
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California
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Connecticut
Delaware
District Of Columbia
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Postal Code*
Country*
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Email*
Home Phone*
Fax #
Purchased From*
Serial Number*
Referred by:
How many people are in your family?
1-2
3-5
6-8
9-12
Number of kitchens in home?
1
2
3
How many Sinks are in the kitchen?
1
2
3
4
Single or Double sinks?
Single
Double
What is the counter top material?
Granite
Formica
What type of sink?
Stainless Steel
Porcelain
Drop-in
How many fixtures?
1
2
3
4
5
6
Is there an instant HOT-COLD dispenser on the sink?
Yes
No
Do you have a garbage disposal unit?
Yes
No
Number of bathrooms?
1
2
3
4+
Number of showers in use at the same time?
1
2
3
4+
Size of main water pipe?
3/4
1
1 1/2
What is your source of water?
Municipal Water
Well Water
If Well Water; How deep is well?
Is the well chlorinated?
Yes
No
What fixtures do you have?
What is pump pressure?
Has your well been tested?
Yes
No
If yes, supply results.
Do you have red or brown stains (rust) on your sink or fixtures?
Yes
No
Do you have any white scale material on fixtures or pots?
Yes
No
Do you know if you have bacteria or parasites in your water?
Yes
No
What is the line pressure coming into your home or business?
Are there any objectionable odors or taste in your water?
Yes
No
If yes, please list?
Do you have a basement?
Yes
No
What height is your basement ceiling?
Is the main pipe accessible in the basement?
Yes
No
Do you have a sprinkler system?
Yes
No
Do you have check or back flow valves?
Yes
No
Is the main pipe accessible after it exits the check valve?
Yes
No
NOTE: Please obtain a copy of your annual comprehensive water report, include: inorganics, THM's, VOC's, all industrial chemicals, pesticides, coliforms and parisites and send it along with this questionaire.
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All prices in US Dollars
Home Water Filters
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Doulton Water Filter
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Shower Filters
Whole House Water Filter
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Reverse Osmosis Machine
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Portable Water Filter
Water Bottle Filter
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Water Filter Replacement
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Auto Senser Faucets
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Water Testing Kits
Home Air Purifiers
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Air Quality FAQs
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Newsletters, Articles
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sales@breproducts.com
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