Commercial Online Warranty Form

Commercial On-Line Warranty Form

Commercial purchasers of our products should either complete this on-line warranty form or mail in the warranty form card within 10 days of purchase in order to validate the warranty.

Company Name*
Primary Contact Name*
First Last
Federal Tax ID#
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Purchase Date*
Purchased From:*
First Last
Model Purchased*
Serial #*
I learned about Pure Water Distillers from:
- Internet Search
- Magazine
- Relative
- Friend
- Radio
- Webinar
- Other
Our tap water comes from:
- City water supply
- Rural water supply
- Well water
For what purpose will this distiller be used?
- Drinking water
- Non-drinking water
- Both
What type of business is this?
- Dental
- Medical
- Laboratory
- Factory
- School
- Institution
- Bank
- Government
- Military
- Other
Primary reason for owning a Pure Water Distiller is...
- Bad tasting water
- Tap water may be unhealthy
- To improve employee relations
- As part of our employee wellness program
- Autoclaves
- Industrial Batteries
- Turbine Wash
- Electronics Wash
- Chemical Mix
- Other
Do you have in-house maintenance staff?
- Yes
- No
If yes, who is responsible for this distiller?
First Last
Phone
Email
Does your company have other locations?
- Yes
- No
Do any of these locations have a Pure Water Distiller?
- Yes
- No
- Don't know
Would any of these locations be interested in a Pure Water Distiller?
- Yes
- No
If yes, who should we contact?
First Last
Phone
Email
Would your employees be interested in units for home use?
- Yes
- No
If yes, who should we contact?
First Last
Phone
Email
We have a blog called www.Watercology.com in which we educate and inspire people to care about the quality of water they put into their body. Do you want to be registered for free?
- Yes, sign me up for free!
Are you interested to learn more about our business opportunity?
- Yes, send me more information and occassional updates.
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