SUPERCOOLERS! Pure Water

SUPERCOOLERS
1272 Mysty Woods
Victoria, BC V8Y 3G6

Phone: 250-595-5974
Fax: 250-595-5984
Toll Free: 1-800-677-0990

Thank you for choosing to contact us. Please answer the following set of questions when contacting us so that we may better assist you.

* - Denotes a required field.

* Your Name:
Company Name:
* Phone Number:
Alternate Phone Number:
* Email Address:
* What type of water service are you interested in?	Not sure - please advise
	Watercoolers
	Under Counter
	Whole House
* Approximately how many people, per day, will use this water service?	1-20
	21-50
	51-100
	100-500
	500+
* Do you currently have a water service provider?	No
	Yes, Please indicate which (if known):

* What is your buying timeframe for your water service?	ASAP
	In one month
	In two months
	More than two months
* Please describe any additional details you may have for your water service.