Indiana Whole-Home Water Filtration Pre-Sale Questions
To help customize the best water filtration solution for your home, please complete this form as accurately as possible. If you are unsure about any answer, you may leave it blank.
This questionnaire helps our specialists better understand:
- Your local water conditions
- Your water goals
- Existing equipment
- Proper system sizing
- Installation requirements
Whole-home systems should only be installed by licensed and bonded professionals familiar with this type of equipment.
Personal Information
Full Name:
Address:
City:
State:
ZIP Code:
Email Address:
Phone Number:
Preferred Contact Method:
☐ Phone Call
☐ Text Message
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Water Source Information
What type of water source does your home use?
☐ City / Municipal Water
☐ Private Well
☐ Community Well
☐ Other (please specify): __________
If treated by a provider, please list provider name:
Provider Name:
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Water Quality Concerns & Goals
Are you experiencing any of the following?
Taste Issues?
☐ Yes
☐ No
If yes, please describe:
Odor Issues?
☐ Yes
☐ No
☐ Hot Water Only
If yes, please describe:
Staining?
☐ Yes
☐ No
If yes, what color?
☐ Orange / Rust
☐ Black
☐ Blue / Green
☐ Brown
☐ Other: __________
Film or Slime?
☐ Yes
☐ No
If yes, please describe:
Hard Water Scale or Mineral Buildup?
☐ Yes
☐ No
What are your primary goals for your water?
☐ Better Drinking Water
☐ Softer Water
☐ Reduce Contaminants
☐ Improve Taste & Odor
☐ Reduce Iron or Sulfur
☐ Protect Plumbing & Appliances
☐ Whole-Home Filtration
☐ Salt-Free Water Conditioning
☐ H2 / Hydrogen Water
☐ Alkaline Water Optimization
☐ Other: __________
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Existing Water Treatment Equipment
Are you currently using any water treatment products?
☐ Yes
☐ No
If yes, please select all that apply:
☐ Salt Softener
☐ Reverse Osmosis
☐ Whole House Filter
☐ UV Light
☐ pH Correction
☐ Iron Breaker / Iron Filter
☐ Countertop Filter
☐ Under Sink Filter
☐ Other: __________
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Installation Information
Preferred Installation Location:
☐ Inside
☐ Outside
Main Water Line Pipe Size:
☐ ¾”
☐ 1”
☐ Other: __________
Is irrigation connected to the main water loop?
☐ Yes
☐ No
Is a pool or spa connected to the water system?
☐ Yes
☐ No
If yes, estimated gallons:
Do you currently have a licensed plumber or contractor?
☐ Yes
☐ No
☐ Need Recommendations
Would you like assistance connecting with certified professionals in your area?
☐ Yes
☐ No
Home Information
What size home do you live in?
☐ 1 Bedroom
☐ 2 Bedroom
☐ 3 Bedroom
☐ 4+ Bedroom
Approximate Square Footage:
Well Water Details (If Applicable)
Well Type:
☐ Private
☐ Community
☐ Unsure
Well Depth:
Date of Most Recent Water Test:
Estimated Well Production (GPM):
Is installation located in a well house?
☐ Yes
☐ No
Distance From Well House To Main Home:
Terrain Between Well House & Home:
☐ Uphill
☐ Downhill
☐ Neither
Pipe Size In Well House:
☐ ¾”
☐ 1”
☐ Other: __________
If community well, please provide well name:
Bottled Water Usage
Approximately how much do you spend on bottled water each year?
☐ Under $100
☐ $100–$300
☐ $300–$600
☐ $600+
☐ Unsure
Financing & Updates
Would you like information about financing options?
☐ Yes
☐ No
Would you like to receive:
- Water quality updates in your area
- Special offers and discounts
- New equipment information
- Advanced water filtration updates
☐ Yes
☐ No
We respect your privacy and do not sell or share your information.
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Customer Acknowledgement
UltraWater Solutions products are tested in certified independent laboratories using EPA standards. Performance may vary depending on environmental conditions, water quality, seasonal changes, and installation quality.
Whole-home water filtration systems should only be installed by licensed and bonded plumbers or qualified contractors to ensure:
- Proper installation
- Compliance with local building codes
- Reduced risk of leaks or water damage
Customers assume responsibility for installation arrangements and ongoing maintenance requirements.
Well water owners are responsible for proper well testing, treatment, and annual maintenance.
Salt-free systems may temporarily loosen existing scale buildup in plumbing. During this process, some homeowners may notice particles, flaking, or temporary sediment as the system works to reduce scale accumulation.
By submitting this form, you acknowledge that the information provided is accurate to the best of your knowledge.
