Quality Water
Information Request Form
First Name
Last Name
Email Address
Cell Phone #
How did you hear about us?
Water Source:*
Please select...
City/Municipal Water
Private Well
Shared Well
If municipal, which system are you on?*
Please select...
City of Santa Cruz Water Dept.
Soquel Creek Water Dist.
Scotts Valley Water Dist.
San Lorenzo Valley Water Dist.
Trout Gulch Mutual water Co.
Central Water Dist.
City of Watsonville Public Works
Pajaro Valley Water Mgmt. Agency
OTHER
Any water treatment equipment already on site? Please describe:*
Reverse Osmosis
Softener
Sediment Filter
Carbon Filter
Iron Filter
Ozone
Ultraviolet (UV)
OTHER
How can we help you with your water?*
Water has off taste
Water has off color
Water has off odor
Scale buildup on faucets/fixtures
Spotting on dishes
Staining in dishwasher
Staining in toilet bowl
Staining in shower
Staining on clothing
OTHER
