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New Customer Water Delivery Inquiry

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Question 1 of 12

First and Last Name

and Business Name (If applicable)

Question 2 of 12

Email Address (will be used for sending delivery invoices)

Question 3 of 12

Phone Number

Question 4 of 12

Delivery Address:

Question 5 of 12

What type of water would you like? 

(Select all that apply)
A

Purified

B

50/50 (Half Purified, Half Alkaline mixed together, around 8.5-9 pH)

C

Alkaline (High pH water with minerals added, over 10 pH)

Question 6 of 12

What Size Bottles?

(Select all that apply)
A

5 Gallon BPA-Free

B

3 Gallon BPA-Free

Question 7 of 12

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

 

Question 8 of 12

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 the first week of every month

A

I will request deliveries as needed

B

I would like a set schedule with automatic deliveries

Question 9 of 12

Do you need to purchase a cooler or dispenser as well?

 

If you know which model you would like from our website, please let us know here. Otherwise we can discuss options.

Question 10 of 12

Would you like the delivery ASAP or a specific date.

Question 11 of 12

What other fees are there?

 

1. There is a $10 delivery fee (No Delivery Fee for Middleton addresses)

 

2. One-Time Bottle Deposit of $5 per bottle.

 

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 12 of 12

Do you have any other question or anything we should know?

Confirm and Submit