Water Softener Salt Delivery Request

Request Delivery Service

Are you an existing customer of U.S. Water?
YesNo

Are you subscribed to our Monthly Maintenance Program?
YesNo

What item(s) do you need delivered? (We can help you if you're not sure):

If you have an existing estimate or quote number, enter it here:

NOTE: We will contact you before delivery to let you know the total amount that will be due for your order. Payment is due at the time of delivery (COD) by cash, check, or money order, or you can pre-pay online by credit card at www.uswater.com/payments. If you are a current Monthly Maintenance Program subscriber you will be billed.

Check One:
I will pay by cash, check, or money order at the time of deliveryI will pay online in advance by credit cardI am a Monthly Maintenance Program subscriber

Will someone be home at the time of delivery?
YesNo

Your Name (first & last):

Deliver to: (street, city, state, zip):

What COUNTY is the delivery address in?

Your phone:

Your email:

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Enter the letters or numbers above into the box below: