Retail Warranty Card
Please fill out the form below. Fields marked with an astrisk(*) are required

  *First name
    *Last name 
*Street Address
Appt. No.
*Zip Code
Price Paid excluding tax
and installation costs  

*Date of Purchase  
*Product Description   *Model Number 

1. Is this your first Culligan purchase?
2. *Where this product was purchased?

3. Where do you intend to purchase replacement filters?
4. How did you first become aware of this product? (Choose one)

Specify Other  
5. What influenced you most to buy a filter at this time? (Check all that apply)

6. What factors most influenced your decision to buy a Culligan brand product over another brand? (Check all that apply)

7. Who did (or will do) most of the work to install this product?

8. How easy or difficult was the installation of this product?

Please provide any feedback regarding the installation procedure:

9. What other brands did you seriously consider before making this purchase?

Specify Other:
Tell us more about yourself
10. Age: 

11. For your primary residence, do you:

12. Highest education level attained: (Choose one)

13. Would you be interested in receiving product information or special offers?
14. Would you be interested in receiving an email reminder to replace your filter?
15. Would you be interested in participating in a future research study?