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* 1. Your Source of Water Supply?

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* 2. Is the color of your tap water?

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* 3. Do you get a scummy ring in your tub?

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* 4. Do you get mineral deposits on your sinks & faucets?

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* 5. Does your water stain Bathroom Fixtures? 

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* 6. Do your dishes look cloudy after going through the dishwasher?

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* 7. Do you buy bottled water?

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* 8. Do you own a water treatment system?

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* 9. Are you concerned about water quality?

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* 10. Number of Persons in household:

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* 11. Are you 

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* 12. What do you dislike most about your water?

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* 13. What is your first name?

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* 14. What is your phone number?

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* 15. What is your email address?

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* 16. Do we have permission to contact you?

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