What is your first and last name?

What is your street address?

Account #

What is your relationship with this service address?

Service Type

What year was your house or business built? Please list date or estimated date. If unknown, please write “unknown”.

What year was your service line installed?

What is your water service line material? Your water service line is the line running from the water meter into your house.

What size pipe is your service line?

Was your service line installed by the previous owner?

Do you have a point of use filter on a faucet, reverse osmosis under the sink filter system, or whole house water filter or softener in use?

If you answered yes to the previous question, list the type of filtration you have in use. If answered no, type N/A.