New Lead Form

Only use this form for NEW (NON Bottle Drop) leads that have NOT been scheduled and still NEED to be contacted by call center or contacted again by you to be formally scheduled. IF you scheduled an appointment, please use the "New APPT. Form instead.

Marketer Name * Required

YOUR NAME OR THE ENTITY WHO GENERATED THE OPPORTUNITY

Lead Source Type * Required

Name * Required

BOTH THE FIRST & LAST NAME OF PRIMARY CONTACT (John Smith)

Phone (XXX-XXX-XXXX) * Required

IF KNOWN, OTHERWISE LEAVE BLANK

Co-Owner First Name (Mary)

LEAVE BLANK IF SINGLE

Co-Owner Last Name (Smith)

LEAVE BLANK IF SINGLE

Co Owner Relationship

ONLY LEAVE BLANK IF SINGLE

Co Owner Phone #

IF KNOWN, OTHERWISE LEAVE BLANK.

Address * Required

PLEASE BE SURE TO SPELL CORRECTLY + GET RD/LN/DR CORRECT.

Do they OWN the or rent the home? * Required

Housing Type * Required

Water Source Type * Required

Has Existing Whole House Filtration? * Required

Age Group of Primary Adults

IF KNOWN. OTHERWISE LEAVE BLANK.

# Adults In Household * Required

# Kids In Household * Required

Initial Rating of Water Quality

Any Conditions Experienced?

Chlorine Smell

Sulfur Smell

Other Odors

Cloudy Water

Water Spots

Foul Taste

Gunk/Buildup

Other

Does Anyone In Home Have Eczema or Dry Skin?

Has or Uses...

Fridge Filter

Sink Filter

Berkey or Similar

Reverse Osmosis

NON R.O. Undersink

Water Softener

Whole House Filtration

Unknown / Left Blank

Monthly Bottled h2o Spend?

Avg. Amount Spent Annually on Fridge Filters

Gift Offered? * Required

IF So, How Much? or Leave Blank or Specifically "No Gift".

DOESN'T MATTER IF BIZGIFT, VISA, OR SPECIFIC RETAILER.

Marketer Notes, If Any

UPLOAD- Lead/Appt./Bottle Drop Slip (Only Upload IF Signed).

PREFERABLY SIGNED OR NO UPLOAD IS NEEDED.