SWC Inc. Application Form

Please provide the following information:

Name

E-mail

Street Address

Address (cont.)

City

State/Province

Country

Zip/Postal code

Residence Phone

Business Phone

FAX

Water Analysis & Pre-Installation Report:

Copper Galv'd
Poly Lead

1/2" Main Line
3/4" Main Line
1" Main Line
Automatic Dishwasher
Main Shut-off Operational

Municipally Treated Water
Untreated Well Water
P.S.I. min. 25 - max. 80
Iron Bacteria
Hydrogen Sulfide Gas
W/H set @ 140° F

CaMg (gpg)
Fe (ppm)
Mn (ppm)
TDS (ppm)
PH (units)

House Built In (year) Number of Washrooms
Plumbing Upgraded In (year) Equipment to Serve (people)
Age of Salt-Softener Age of Water Heater

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Name
E-mail
Street Address
Address (cont.)
City
State/Province
Country
Zip/Postal code
Residence Phone
Business Phone
FAX

House Built In (year)		Number of Washrooms
Plumbing Upgraded In (year)		Equipment to Serve (people)
Age of Salt-Softener		Age of Water Heater