We need your help! In order to continually follow and track consumer's expectation of their household water we are asking for your assistance. Your answers to this survey will help us determine the quality of water in your home. By answering this survey you will provide us with important information so we can better understand and address the water concerns of the community.

As a thank you for taking the time to answer our survey and returning it to us we have a special COMPLIMENTARY Gift for you. This gift is a chance to win a three day two nights get away to a Resort Hotel in a city of your choosing.

1. Do you see build up of water spots on your fixtures, countertops and vanities? Yes    No

2. Do you at times notice an unpleasant odor in your water? Yes    No

3. Does your water ever show evidence of discoloration? Yes    No

4. Do you presently treat your water in any manner? Yes    No

5. Do you purchase bottled water? Yes    No

6. Do you have dry, itchy skin? Yes    No

7. Do you notice a soap curd build up in your shower? Yes    No

8. Have you noticed a soap scum ring around your bathtub? Yes    No

9. Have you noticed an unsightly build up of residue within your dishwasher? Yes    No

10. Have you experienced unsightly streaks and spots on your dishes after they have been washed in your dishwasher? Yes    No

11.Have you ever replaced the elements in your water heater and seen a scale build up on the elements? Yes    No

12. Have you ever had to replace your water heater? Yes    No

13. Are you aware that public water supplies are regulated? Yes    No

14. Are you aware that you can take steps to personally choose the quality of water in your home? Yes    No

15. Do any of the above water issues pose a health concern for you? Yes    No

16. Is quality of drinking water an issue for you? Yes    No

17. I am interested in obtaining information on:
   Drinking Water    Bottled Water    Soft Water
   Whole House Water Treatment    Filtered Water for Rust and Odor

Thank you for your help. Please share your name, address and phone number so you can be contacted if you win the complimentary three day, two night stay in a Resort Hotel as well as provide you with any other additional information.

Name
Email
Address
City	State Zip
Phone	Best Time to Call
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