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Complete the Air Quality Survey to receive a Free 1-Room Air Purifier Consultation Present!

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* 1. Does anyone in your home suffer from Allergies or Asthma?

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* 2. Does anyone in the home suffer from a Respiratory Disease?

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* 3. How do you feel about the Outdoor Air Quality in your area?

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* 4. Do you have any Pets in your home?

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* 5. Do you own your home?

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* 6. How do you feel about the Air Quality Inside your home?

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* 7. Are you a Student?

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* 8. Tell us about your self:

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* 9. What is your occupation?

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* 10. Thank You for helping with our Air Quality Survey! Winners of the Clean Air Machine will be contacted by phone. Provide your contact information below.

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