Meter Reads

Monthly Meter Reads

Please fill out & Submit

* Indicates required field

Store Name *

Location *

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 *

**Thank you for using our Online Form; once submitted it will take you to our Current Promo.**

Submit

Monthly Meter Reads

Please fill out & Submit

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.

Thank-You!Please feel free to leave us a message on how we can service you better.

Thank you for using our Online Form; once submitted it will take you to our Current Promo.

CALL US Toll Free at 1-800-284-6315

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.

Thank-You!
Please feel free to leave us a message on how we can service you better.

**Thank you for using our Online Form; once submitted it will take you to our Current Promo.**