To request information on our free basic water analysis offer, which includes tests for Total Hardness, Total Iron, pH (acidity/alkalinity) and TDS (Total Dissolved Solids test for dissolved metals and salts). This is a free water test and there is no obligation for receiving this service. Name Address City State Zip Telephone Email Number of people living in the home? What type of water supply do you have? Municipal(city) Private Well Please check the boxes that apply to you: Spotty dishes/glassware Pinhole leaks in pipes Scale build-up on fixtures/shower heads Shortened hot water heater life Dry skin/scalp conditions Rust or "blue-green"stains Bad taste/odor (chlorine, rotten egg, metallic) Are you concerned about lead in your water? Other      Do you have a water softening system? Yes No If "yes" (check one) Rent Own What type? (check one) Culligan Other   Are you currently using a filter system? Yes No If "yes" what type (check all that apply) Whole house Under-the-sink Single tap Faucet mounted Do you use bottled water? Yes No If "yes" where do you get it from? Supermarket Home delivery (name)   Additional comments: