Fresh Air Survey
Since living in the area, do you believe the air has gotten: *
Does anyone in the family suffer from: *
Required
Do you have Children or Pets? *
Required
Are you married or have a partner that resides with you? *
What do you do for work? *
Your answer
What does your spouse/partner do for work? *
Your answer
Do you own or rent your home? *
What is your age group *
Name (First and Last) *
Your answer
Spouse/Partners Name (First & Last) *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Phone Number *
Your answer
Best time to reach you? *
Name of Facebook friend that sent you to us (first and last name) *
Your answer
If you are selected for the Rainmate from our company, we will reach out to the phone number you provided to set an appointment to deliver your Rainmate Fresh Air Machine. *
Required
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