System Selector Help Form

Quick Response - we will get back to you quickly, typically in less than 24 hours!


Fill in as much information as you have available, but we need at least your name and email address to be able to respond to you. If this is for your home please do tell us the number of bathrooms in your home and/or your well's flow rate so we can properly make a recommendation.

If you would like to have a technician call you during daytime or early evening hours, please give us your phone number. No salesman will call you, but our techs can answer technical questions quickly over the phone.

Contact Info
*Name:
Address:
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Home phone:	Work phone:
Fax:	*E-mail:
Water Source:
Private Well Spring River / Creek
Lake Cistern City water I do not know
Water Chemistry	Water Quality:
Hardness ppm or mg/L	Red/Orange stains Brown stains
Hardness grains	Black stains Blue stains
pH (1-14)	White spots/scale Corrosion
TDS ppm	Bad tastes Bacteria
Iron ppm	Parasites Iron
Manganese ppm	Manganese Chemicals
Tannin ppm	Nitrate High salinity
Nitrate ppm	Heavy metals Sediment
Copper ppm	Color Odor
Alkalinity ppm
Bacteria No Bacteria Coliform Bacteria Fecal Coliform Bacteria Coliform & Fecal Coliform	Other problems
Tested on: - -	Low pressure at certain fixtures but not others
Type of piping I have:
Copper: Galvanized steel: PVC: Other:
Don't know: Diameter of piping: inches
Flow rate information:
HP of well or booster pump (What's this?):
Well flow rate (What's this?):
Water usage information :
Number of bathrooms in home: Swimming pool:
In-floor heating: Solar heating:
Type of Pumping System I Have:
Well > Pressure Tank > House
Well > Storage Tank > Booster Pump > Pressure Tank > House
Well > Storage Tank > Gravity Feed to > House
Other
Please tell us background information or notes here, in particular any problems you are having or questions you have:
Disclaimer:
The information contained here is believed to be reliable and offered in good faith with no warranties or implied warranties or fitness for a particular use. System design suggestions are based on best judgement or estimates considering limited information provided by customer; End-user or the customer is responsible for determining suitability of application and usage under site-specific circumstances, environmental conditions and water quality profile. Clean Water Systems Inc. neither accepts or assumes any liability associated with water treatment system design. No warranty or guarantees are extended to cover piping systems, appliances or other water using fixtures. I agree to hold harmless Clean Water Systems Inc for any information contained herein and take full responsibility for my own water systems and applications.
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