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Ultra-Pure™ Retail Dispensers
Jugs & Accessories
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Meter Reads
Ultra-Pure Dispenser Sanitization Guide
Service Requests
Update Contact Information
Monthly Meter Reads
Please fill out & Submit
*
Indicates required field
Store Name
*
Location
*
City, Province/State
Store Phone Number
*
Your Name
*
First
Last
How is your Ultra-Pure Equipment working?
*
It's working
It's working; but requires some maintenance
It is not working; and I have not called for service.
It is not working; Service is working on resolving the issue.
Additional information about your systems status.
*
IMPORTANT NOTE:
Please enter both the Serial Number & Meter Read for all your meters; if you have more that four meters, please submit multiple forms.
Be sure enter the date the read was taken; the serial number, and the full 7 or 8 digit meter read for
each meter
.
To avoid confusion on the meter reads, please enter the complete numbers as displayed (
including all "0" and partial numbers
.)
Date of Meter Read
*
Meter #1 - Serial Number
*
Meter # 1 - Meter Read
*
Meter #2 - Serial Number
*
Meter # 2 - Meter Read
*
Meter #3 - Serial Number
*
Meter # 3 - Meter Read
*
Meter # 4 - Serial Number
*
Meter # 4 - Meter Read
*
This section is to help us ensure we have your correct email addresses.
If you have already filled this out; don't worry, just keep us posted if changes occur.
Meter Read Request Email
*
Promo Email
*
Invoice Email
*
Thank-You!
Please feel free to leave us a message on how we can service you better.
Comment
*
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.
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Welcome
Sales
Ultra-Pure™ Retail Dispensers
Jugs & Accessories
Contact
Contact Us
Employment Opportunity
Retail Partners Portal
Meter Reads
Ultra-Pure Dispenser Sanitization Guide
Service Requests
Update Contact Information