Thank you for your interest in our drip irrigation kits. Please take a few minutes to fill out this brief form and a member of our team will be in touch with you with more information about our drip kits. Thank you! 

* 1. Please complete the following

* 2. Where are you interested in installing a drip kit?

* 3. How did you hear about our drip kits?

* 4. Why are you interested in drip irrigation? (select all that apply)

* 5. How far do you have to walk to access water?

* 6. How are your crops currently irrigated?

* 7. What size is the plot of land you farm on?

* 9. Which delivery option you would be interested in?

* 10. How many months a year do you grow crops?

* 11. What is the level of food security in your household?

* 12. Please select all that apply:

* 13. Please list any comments or questions you have for our team.