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Well ManagerŪ Questionnaire

Your request for a quotation is very important to us.
Upon receiving your request, we will endeavor to reply within one business day.
Please answer as many of the questions below so we can provide you with an accurate and competitive quote.


Contact Information
 Name
 Address
 City
 Prov/State
 Postal/Zip
 Country
 Email
 Phone
 Fax

Questionnaire
 What problems are you having with your well and plumbing services?
 What attempts have been made so far to correct this problem?
 What would you like to be able to do in and out of your home?
 How much money have you budgeted for this project? $4,000-$4,999 $5,000-$6,000
$7,000-$10,000 over $10,000
 Total number of occupants in the house
 Number of bedrooms
 Number of bathrooms
 Do you have high volume plumbing fixtures in your home? whirlpools, multi-head shower systems etc. If so please explain
 Do you have overnight guests if so how many and how often?
 Do you want to be able to use water outside of the house? If so for what purpose?
 Do you have an in ground irrigation system?
 Do you have a pool? no yes
 Do you have any water treatment/filtration equipment? If so what type of equipment, and what water quality issues are there?
 Diameter of your well
 How deep is the well?
 What is its' yield?
 Static water level
 Do you have more that one well? If so how many
 What depth is the pump set at?
 What is the make and model number of your well pump?
 How far is the well from the house?
 Where is the pressure tank located?
 What is your pressure switch set for? 20/40 30/50 40/60
 Are there any yard hydrants between the pressure tank and the well? no yes
 Where did you plan on installing the Well ManagerŪ?
 What are the dimensions of the doorways to get to this room?
 How much room do you have for the Well ManagerŪ?
 Do you plan on installing the Well ManagerŪ yourself or hiring a contractor?
 Do you have room in your electrical box for more breakers?
 Do you have any questions at this time?
Thank you for taking the time to complete the above document. We realize you will not have all the answers, but this will give us a good base needed to design a system to fit your wants, needs, space and budget. If you have questions, please feel free to contact us at any time.
ALL INFORMATION IS HELD STIRCTLY CONFIDENTIAL