Waterwise Logo FREE SHIPPING on all orders of $199 or more!

For a limited time, take advantage of FREE SHIPPING on all orders of $199 or more that ship to the Continental USA.

Orders less than $199, add 9% of merchandise total for shipping ($9.00 minimum). HI, AK, PR, and Canada add 16% ($16.00 minimum).

Please contact us with any questions.
Waterwise Inc
3608 Parkway Blvd Leesburg FL 34748
Toll-Free 1-800-874-9028 M-F 9am–5pm ET

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DOMESTIC DEALER QUESTIONNAIRE

PERSONAL  
First Name
Last Name
Address
City
State/Province
Country
Zip/Postal Code
Telephone
Fax
   
BUSINESS  

Business Name

Date Business Started
Your Position
Mail Address
City
State/Province
Country
Zip/Postal Code
   
Ship to  
Attention
Address
Address 2
City
State/Province
Country
Zip/Postal Code
   
Telephone
Fax
E-mail
E-mail Confirmation
Web Site
   
Business is:
   
Purchase Order Required?
Best Time To Call
   
Brief Description of Business
   
GENERAL  
What type of water do you drink?
1
Tap 4
RO
2
Bottled 5
Filtered
3
Distilled  
 
Do you presently use/sell water distillation systems?
1
Yes
2
No
3
Brands
4
Never Used or Sold
How did you find out about Waterwise?
1
Magazine
2
Internet
3
Friend
4
Trade Show
5
Radio
6
Other
Do you currently own a Waterwise product?
1
Yes
2
No
Can you meet a minimum first order of $3000?
What time would you devote to this business?
1
Part-time
2
Full-time
Start Date
What sales territory could you effectively cover?
Why are you interested in and what are your goals related to the water purification business?
I understand that this is not a contract nor does it constitute an agreement toward partnership and/or representation. It is for informational purposes only. I certify the accuracy of the above information.