ZeroWater - Shop

Product Registration

Dear Customer,

Thank you for purchasing ZeroWater® Products!
Please complete this form to activate your product registration!

Because we realize that privacy is important, we respect the confidentiality of personal information provided and treat that information responsibly.

Thank you for purchasing our product!

-Zero Technologies LLC.

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First Name:
Last Name:
Street:
City
State:
Zip:
Phone:	() -
Optional Alternate Phone:

User Account Creation
Email:
Account Password:
Confirm Account Password:

Date of Purchase:
Year:	Month:	Day:

Product Purchased:
ZeroWater® Pitcher
ZeroWater® Bottle Filtration System
Glass Carafe Dispenser
Tester(Electronic Water Tester or TDS Meter)
EIGHTZeroWater® Replacement Filters - Eight Pack
FOURZeroWater® Replacement Filters - Four Pack
D'Vinci Cooler and Bottle Filtration System
Cooler Cleaning Kit
Black Floor Stand
Black Counter Stand

Previously, primarily used: (pick three only):
Tap Water
Bottled water(individual bottle)
5-gallon bottled water(delivery service type bottle)
Pitcher filter
Faucet filter
Fridge filter
In Line system
Distillation
Reverse Osmosis
Other

Main reason for purchase:(pick one only):
Better water quality
Cheaper cost of good water
More convenient
Other

Usage Information:
Tap water TDS reading:
Number of people in household:
Estimated gallons of drinking water consumed per day:

Filter Replacement Program:
Would you be interested in information about a convenient filter replenishment program that would automatically ship you replacement filters every 30,60,90 or 120 days(as you choose)?	Yes No

In the future, we would like to contact you about replacement filters, as well as other special promotions. What is the best method for us to contact you?
Phone - live agent
Phone - voice mail
Email
Mail
Do Not Contact

ZeroWater is interested in having you join our product development team! Would you be interested in receiving additional FREE SAMPLES, participating in product trials and providing valuable feedback, which will lead to better products in the future?
Yes sign me up! Please provide phone & email above.	No thanks.

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