Dealer Name: _____________________________________________
Dealer Address: _____________________________________________
Web Address: ______________________________________________
E-mail Address: ____________________________________________
Dealer Phone: _____________________________________________
Salesperson Name: __________________________________________
Model Number: ____________________________________________
Date Installed: _____________________________________________
Number of People in Household: ______________________________
Meter Disk Number: ________
Ferrous Iron: _______________ ppm
pH: ______________________
Hydrogen Sulfide: __________ ppm
Temperature: ______________
Hardness: ___________ gpg
Ferris Iron: __________ ppm
TDS: _______________ ppm
Pressure: ____________