Water for the Global Community Unit Request Form

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Please fill out the questions below so that we can assess suitability

Email *

What is the name of the community the unit will be located? *

How many people will be served by the unit? *

1-25

26-50

51-100

100+

What is the current state of potable water in the location? Please be as detailed as possible. *

Would you want an electric or non-electric unit? *

Electric

Non-electric

What is the name of the person who would be responsible for the care of the unit? *

What is the name of the organization who would be responsible for the care of the unit? *

Please provide all contact information for all parties involved. *

What port should the unit be shipped to for pick-up? *

You would be required to arrange local delivery from the port to the final destination. Would you be able to coordinate this? *

Yes

Maybe

We require periodic reports on the performance of the unit. Would you be able to provide this? *

Yes

Maybe

We will require a water test before and after filtration. Would you be able to provide this? *

Yes

Maybe

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