* 1. Please enter your contact information in the boxes below.

* 2. Please respond to each question below.

  Yes No
Do you currently have a water filter for your faucets?
Do you need any help installing your water filter(s)?
Do you have replacement cartridges for your water filter(s)?
Do you need a water test kit for your home?
Do you have enough bottled water for mixing formula, drinking, tooth brushing, and cooking?
Would you like more information about lead and what to do about it?
Do you need help obtaining any of the items listed above that you do not have?