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New Customer Water Delivery Inquiry

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Question 1 of 15

First and Last Name

and Business Name (If applicable)

Question 2 of 15

Email Address (will be used for sending delivery invoices)

Question 3 of 15

Phone Number

Question 4 of 15

Delivery Address:

Question 5 of 15

Pricing:

 

Purified - Pure, Clean Water, Nothing Added

3-Gallon Bottle $7.50

5-Gallon Bottle $12.50 

 

Alkaline - Magnesium & Calcium Blend of Minerals Added, 9.5+ pH

3-Gallon $9.50

5-Gallon $15.50 

 

 

A

I Understand

Question 6 of 15

What type of water would you like? 

(Select all that apply)
A

Purified

B

Alkaline (High pH water with minerals added, 9.5+ pH)

Question 7 of 15

What Size Bottles?

(Select all that apply)
A

5 Gallon BPA-Free

B

3 Gallon BPA-Free

Question 8 of 15

We recommend after loading your last bottle, you fill out our easy delivery request form on our website or reach out to us by phone/email to request a delivery.

 

Deliveries are usually made 1-2 days after the request.

 

If you would like a set schedule of automatic deliveries, let us know. Example: Delivery every 4 week, 8 weeks, etc.

A

I will request deliveries as needed

B

I would like a set schedule with automatic deliveries

Question 9 of 15

How many Bottles would you like delivered? (Minimum of 4 bottles total, minimum may increase depending on distance). If you selected more than 1 type of water, please specify how many bottles of each.

 

Question 10 of 15

Do you need to purchase a dispenser as well?

 

If yes, We currently only offer a Ceramic Room Temp Dispensers that you can view at our website www.freshwaterdaily.com. Click on the "Shop" tab.

 

If you prefer an electric Hot/Cold type cooler, you can find options online or at certain stores such as Walmart, Home Depot, BJ's/Costco, etc.

 

There is no obligation to purchase one of our dispensers to start delivery service if you prefer to purchase your own cooler/dispenser elsewhere.

A

Yes, I would like a Ceramic Room Temperature Dispenser

B

Yes, but I will purchase a Cooler/Dispenser somewhere else

C

No, I already have one

Question 11 of 15

Would you like the delivery as soon as possible or a specific date?

Question 12 of 15

What other fees are there?

 

1. There is a minimum $10 delivery fee, can vary depending on location

 

2. One-Time Bottle Deposit of $5 per bottle. Deposit is refunded upon ending service and bottles being returned.

 

3. Stair Fee (If no elevator):

$15+ depending on how many bottles and how many flights of stairs

 

If you have bottles from somewhere else, please let us know on the next question how many and we can adjust or waive the bottle deposit.

A

I understand

Question 13 of 15

We offer a 15% discount on deliveries for Senior Citizens, First Responders, and Military. Please check any boxes that apply to you.

 

(Select all that apply)
A

Senior Citizen (65+)

B

First Responder (Fire, Police, Paramedic, etc.)

C

Military (Active or Veteran)

D

None

Question 14 of 15

How did you hear about us? 

Question 15 of 15

Do you have any other comments or questions? (If you are a Business, please list your Business hours for deliveries here)

Confirm and Submit