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Name: ________________________________ _____________
Address: ________________________________ ___________
City: _____________ State: ____________ Zip Code: ______
Phone#: ________________ Fax# ______________________
1. Grains if
2. ppm's if
3. Do you have iron present
your
4. Had you installed an Iron
prior to purchasing
ClearWave™
5. Where did you purchase
ClearWav ™ from?
6. Date
7. Mfg. date
Hardness
Level
One
Light:
1-3 grains
17-51
Moderate
4-6 grains
52-102
Hard:
7-10
103-170
ppm
Very
10 grains
above
170 ppm
above
✃
e
™ Warranty Registration
e
™
YES
If Yes, circle one
NO
YES
ppm's if Known
NO
Briefly describe any current water
problems; scale build up, odor, taste,
staining, etc... ____________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
Page 8
Light
Moderate
Heavy
Very Heavy
(ppm-Parts Per Million)
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