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Note: Fields flagged by * are mandatory fields

First Name *
Last Name *
Address *
City *
Province/State *
Postal Code *
Telephone Number *
Email Address *
Product Model *
Serial Number *
Date of Purchase *
(DD/MM/YYYY)
Dealer Name *
Name of Installer
Water Source
Surface Water
Well

Application
House
Cottage/Vacation Property
Commercial/Industrial
Municipal
(school, hospital, etc...)

Has your water been tested for
Microbial Contamination
UV Transmission
Iron
Hardness
How did you learn about the product you purchased?
To Reach UV Pure contact:

Tel: 416.208.9884 ext. 229
Toll Free: 1.888.407.9997 ext. 229
Fax: 416.208.5808

Email: customercare@uvpure.com


           
 
 
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