________________________________________________
________________________________________________
Dealer Address: ________________________________________________Dealer Address:
________________________________________________
_______________________________________________
________________________________________________
_____________________________________________
Salesperson Name: _____________________________________________Salesperson Name:
_____________________________________________
Other Equipment: _____________________________________________Other Equipment:
_____________________________________________
______________________________________________
________________________________________________
Number of People in Household:
________________________________
Meter Disk Number: ______Meter Disk Number:
Hardness: _________________ Hardness:
ppm Ferric Iron: _______________ ppm Ferric Iron:
_______________ ppm _______________
TDS: ____________________ TDS:
____________________ ppm ____________________
Hydrogen Sulfide: ________Hydrogen Sulfide: