*Name
*Email
*Phone1
Phone2
Street Address
City, State, Zip
Are you pre-plumbed for a water softener? Choose Yes, however we do not have an operating softener Yes, and we presently are using a softener No, we are not pre-plumbed for a softener I don't know, please come and check
If you are pre-plumbed for a water softener, where is it located? If yes... The hook-up is in the gargage The hook-up is in the house The hook up is outside
Do you have a drinking water system in place? Choose Yes No I don't know, please come and check
What is your water source? Choose City water Well water Rural I don't know
Do you own the home? Choose Yes No
Rate your water's hardness Choose Soft Hard Very Hard I do not know
Any odors or bad tastes in your water? (Check all that apply) Chlorine Rotten Egg Metallic Stale None Other
Color of tap water? (Check all that apply) Cloudy Rusty Milky Clear Other
Any staining? Choose Yes No
If using WELL WATER, would you like a thorough test of your water? Choose Yes No Our report is a detailed water analysis of the water in your area.
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Comments/Questions/Concerns:
Please note: By submitting this form, you verify that you are the individual listed above and that you are over the age of 18. Also, by submitting this form, you agree that a Hague representative may telephone you even if your number is found on a statewide or national 'Do Not Call' registry or list. (The information gathered here is private and we do not share, sell, or distribute this information in any way.)