Dealer Name: ________________________________________________
Dealer Address:
Dealer Address:________________________________________________
Dealer Address:________________________________________________
Web Address: ________________________________________________
E–mail Address: _______________________________________________
Dealer Phone: ________________________________________________
Salesperson Name:
Salesperson Name:_____________________________________________
Salesperson Name:_____________________________________________
Other Equipment: _____________________________________________
Other Equipment: _____________________________________________
Other Equipment:
Model Number: ______________________________________________
Date Installed: ________________________________________________
Number of People in Household: ________________________________
Meter Disk Number:
Meter Disk Number:______
Meter Disk Number:______
Ferrous Iron: ____________ ppm
pH: ___________________
Hydrogen Sulfide:
Hydrogen Sulfide: ________
Hydrogen Sulfide: ________
Temperature: ____________
_____________________________________________
ppm
ppm
ppm
Hardness:
Hardness: _________________
Hardness: _________________
Ferric Iron:
Ferric Iron: _______________
Ferric Iron: _______________
_______________
_______________ ppm
TDS:
TDS: ____________________
TDS: ____________________
____________________
____________________ ppm
Pressure: _____________________
gpg
ppm
ppm
12