Aqua-Pure

*Fields with are required fields and must not be left blank.**
Warranty Form
Model No: *
Other Model: *
	If your model is not the the drop down list you must enter it here.

Name: *
Address: *
Suburb: *
State: *
Postcode: *
Phone:
Date of Purchase: *
Email: *
Dealer's Name: *
Dealer's Address:
Dealer's Suburb: *
Dealer's State: *
Dealer's Postcode: *

In order to provide better products & service, we would appreciate you taking a few moments to provide some feedback by answering the questions below.

1. Gender of purchaser Male Female

2. Age of purchaser Under 20 20 - 29 39 - 39 40 - 49 over 50

3. If you wish to, please indicate your total annual household income (optional) under $19k $20k - $39k $40 - $59k $60k - $99k $100k +

4. How or where did you make the filter purchase? via plumber visit to a plumbing supply store visit to a hardware store other

5. How long did the decision to purchase a water filter take? planned for months (please enter number of months in box) purchased shortly after decision was made impulse purchase while shopping

6. What were your reasons for purchasing a water filter? friends had one dirt / rust / sediment problem chlorine / taste / odour problem giardia or cryptosporidium cyst concers general concern about mains water quality

7. If you purchased a water filter requiring installation, who has / will install the water filter? did it yourself friend or relative plumber under $80 cost plumber $80 - $150 Plumber over $150

Any comments regarding installation?

7. do you wish to receive product information & updates? yes no

Warranty does not include cartridge.

We collect your personal information so we may provide you with updates and a cartridge replacement reminder service. We may also use your personal information to tell you about Aqua-Pure initiatives, experiences or relevant information that we have come across and that we believe may benefit you. We will not sell, lend or give out our database to any other organisation, however your personal information will be included in the form of an entry in our database which will be provided to our contracted services providers, such as our mailing house, who help us with our administrative activities from time to time.

You may access or request removal your personal information at any time.
Please call 1300 345 837 or email us at cunoau@mmm.com

Cartridges supplied are Model No. AP9112.