Retail Warranty Card
Please fill out the form below. Fields marked with an astrisk(*) are required
Mr.
Mrs.
Ms.
Miss.
*First name
Mi
*Last name
*Street Address
Apt. #
*City
*State
*Zip Code
*Telephone
*Email
Price Paid excluding tax
and installation costs
$
*Date of Purchase
*Product Description
-Select-
Drinking Water – Faucet Mount
Drinking Water – Pitcher
Drinking Water – Refrigerator/Ice Maker
Drinking Water – Under Sink
Drinking Water-Refrigerator/Ice Maker
Filtered Shower Head
RV/Marine
Whole House Sediment
*Model Number
1. Is this your first Culligan purchase?
Yes
No
2. *Where this product was purchased?
-Select-
ACE
AMAZON.COM
CULLIGAN-STORE.COM
LOWE'S
OTHER
3. Where do you intend to purchase replacement filters?
 
4. How did you first become aware of this product? (Choose one)
Recommendation-Friend/Relative
Web site/internet
Store display
TV or Newspaper AD/Insert/Review
Other
Specify Other
 
5. What influenced you most to buy a filter at this time? (Check all that apply)
To Improve taste
To eliminate odors
To reduce chemicals/impurities
Medical/health reasons
New baby
Recent water quality concerns
Remodeled kitchen
Moved to new apt/home
6. What factors most influenced your decision to buy a Culligan brand product over another brand? (Check all that apply)
Received as gift
Brand reputation
Previous experience with Culligan
Ease of installation
Style/appearance
Only Option
Warranty
Friend/relative recommendation
Value for the money
7. Who did (or will do) most of the work to install this product?
Self
Friend/relative
Professional installer
8. How easy or difficult was the installation of this product?
Unknown-installed by someone else
Very easy
Relatively easy
Somewhat difficult
Very difficult
Please provide any feedback regarding the installation procedure:
 
9. What other brands did you seriously consider before making this purchase?
None
Brita
GE
Omni
Pur
Sears/Kenmore
Whirlpool
3M
DuPont
Other
Specify Other:
Tell us more about yourself
10. Age: 
Under 18
18-24
25-34
35-44
45-64
65+
Male
Female
Married
Single
11. For your primary residence, do you:
Rent
Own
Reside on college campus
Assisted Living Facility
12. Highest education level attained: (Choose one)
High school
College/Tech school
Grad school
13. Would you be interested in receiving product information or special offers?
yes
no
14. Would you be interested in receiving an email reminder to replace your filter?
yes
no
15. Would you be interested in participating in a future research study?
yes
no