Survey



Name:	Last First	1. How long have you been a PURELOCK™ Customer? 0 Days 1-30 Days 31-60 Days 61-90 Days Over 90 Days

Contact Info:	Email Phone	2. How did you hear about PURELOCK™? Friend Use it at Work Radio Ad Magazine Ad My Delivery Company TV Ad Newspaper Other 3. Why do you use PURELOCK™ over 3 or 5 gallon bottles? Lighter Weight Storage Appearance Environmental Benefits Convenience Sanitation Peers Use It No Deposits/Returns

Select Your State:		4. Overall, how would you rate your level of satisfaction with PURELOCK™? Completely Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Completely Dissatisfied

Select your Provider:		5. Would you recommend PURELOCK™ to your peers? Strongly Agree Agree No Opinion Disagree Strongly Disagree

Comments or Suggestions Regarding PURELOCK™