Contact Person*

Company

Email Address*

Phone Number*

Address*

City*

Province/State*

Country*

Smart Valve™ Size*
---0.75 Inch1 Inch1.5 Inch2 Inch3 Inch4 Inch6 Inch8 Inch10 Inch12 Inch

Distributor*

Invoice*
(Only PDF, doc and docx accepted)

Invoice Number*

Invoice Date*

Installation Address*

Installation Date*

Installed By*
(Name of plumbing company or in-house plumber)

Attach Photo of Installed Smart Valve™*
(Only jpg, jpeg, png and gif accepted)

Attach Additional Photo
(Only jpg, jpeg, png and gif accepted)

Attach Additional Photo
(Only jpg, jpeg, png and gif accepted)

Primary Water Usage*
(potable/drinking water, irrigation, manufacturing, other; please describe)

Property Type*
(single-family home, multi-tenant apartment, hotel, restaurant, car wash, etc.)

Building Number of Stories*

Water Company/Municipality*

Approximate City Water Pressure at Property*