Contact Information:

Who should we contact regarding this proposal?

Additional Contact Names

Name, Title, Email
Name, Title, Email
Name, Title, Email
Name, Title, Email
Name, Title, Email

Organization Details:

Tell us about your school or childcare center

Institution Name *

Institution Type *

School District or Organization Name

Address

Street Address

City

State

Country

Postal code

Number of Students/Children Served

Number of Buildings

Water Filtration Needs:

What type of filtration solutions are you interested in?

Water outlet counts to be fitted with filters

Standard Faucets
Kitchen/Cafeteria Sinks
Hose spigots
Other

Upload Your Current Fixture Inventory or Drinking Water Management Plan (DWMP) (If Available)

Special Considerations

Are you interested in providing your athletes with Electolyzed Reduced Water?

Yes

No

Unsure, need assistance

Are you interested in producing Hypochlorous Acid for your cleaning solutions?

Yes

No

Unsure, need assistance

Education & Compliance Support Needs

Would you like assistance with staff and parent education as suggested by EGLE?

Preferred Education Format (Check all that apply):

Do you require signage for sinks and/or new filters?

Budget Considerations

Help us tailor a solution that meets your budget needs.

Does your facility need to comply with Michigan’s Filter First Legislation? *

Are you currently receiving funding from the Filter First – Healthy Hydration Grant? *

Do you have an estimated budget for this project? *

Preferred Installation Timeline *

Would you like professional install?

Are you interested in the following (check all that apply)

Bulk discount pricing

Auto-ship filter discount

Non-profit tax exemption

Any special requirements or concerns?

Please describe any specific concerns or requests for your facility’s water filtration needs.

Would you like a free consultation to discuss your needs? *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.