FREE water analysis for our customers

Water Analysis Virgin Pacific Water Inc.

Please fill out this form and print. Send with your water sample.

Name:

Address:

Phone#

Fax#

E-mail:

System you are most interested in?

Concerns you have with your water. Please check boxes.

What is your main water source?

If well water, how often do you chlorinate your well?

If any, what type of water treatment do you currently have?

Please send a minimum of 8 oz. to Virgin Pacific Water Inc. Attn: water sample

2575 Fortune Way Suite J

Vista CA 92081

Please print out a copy of this form and send it with your sample.

Virgin Pacific Water Inc. E-mail sales@virginpacificwater.com

Fax# (760) 734-5798

Additional Notes:

How did you here about us?

NOTE: WE DO NOT TEST FOR ANY BIOLOGICAL CONCERNS. PLEASE CONTACT YOUR LOCAL WATER DISTRIBUTOR FOR ANY OF THESE MATTERS. THANK YOU