Dealer Location Request Form

Products

Water purifiers

Air purifiers

Waterless cookware

Juice Extractors

Cutlery

Food storage containers

Things to know

Facts about water

Facts about air

Cookware info & FAQ

Juicing facts

Vacuum packing

Dealer Location Requst Form

To help us find the nearest/most convenient dealer for you, we would like to find out some information about you. Please fill out the following form and we will contact you.

First Name:

*Required

Last Name:

*Required

Address:

*Required

City:

*Required

State/Prov.

*Required

Country:

*Required

ZIP/Postal Code:

Phone #:

*Required

E-Mail

*Required

Which Product(s) are you interested in? (click any that apply)

Portables		Centrals
If you want information on a specific product, select from the list below
XR-20	Model 300	2500 HV	4000 HV
Model 1200	Model 1700	AWW-350	AWW-675
6000V Cart	7500 Cart	6000V	6500
Nutri-tec 6 stage	Nutri-Tech 10 stage	8500	10,000

What are you looking to buy : *Required
New System(s) or Replacement Filter(s)

Are you comfortable with buying from a Water Products representative online? *Required
yes no

The Following is OPTIONAL information:

Do you or anyone in your family suffer from:
Allergies, Asthma, Other Respiratory Problems

Where did you hear about the Water Products company?

Is this purchase going to be for: Commercial or Residential use?
If Residential, will it be used in an: Apartment or a House?

Thank you,

(the form will send as an e-mail through your default e-mail program, you may need to hit 'send' from there)

What Water Products are you interested in?

Water Filters	Air Filters
Waterless Cookware	Juice Extractors
Food Storage Containers	Free Water Filter Program