Put your water to the test. Find out what's in the water you drink and use. Water contaminants and impurities can affect your health and reduce efficiency in household appliances. At Keppler Culligan Water Treatment, we know that the key to providing you with the optimum water treatment system is to first have a thorough understanding of your specific water treatment needs. 

This is a free water test and there is no obligation for receiving this service.

Water Analysis Form

*First Name:
*Last Name:
*Address:
*City:
*State:
*Zip Code:
Phone:
*Email:
Best time to reach you:
Do you own a home?	Yes No
What is your water source?	Well Municipal Other
Are you satified with your water quality?	Yes No
Do you buy bottled water?	Yes No
From Whom?
Which of the following conditions do you experience?
Chlorine Bad Taste Rotten Egg Smell Rust or Blue-Green Stains Spots on Dishes and Fixtures Murky or Sediment in Water Excess Lint in Dryer Replaced hot water heater in last 5 years
When was the last time you had your water tested?
What methods do you use to treat your water now?
Small Whole House Filter Softener Other None
Comments:
	* Required Information