| Addressed TO: |
..............................Priority:
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| Your name: |
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| Your E-mail: |
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| Subject: |
po
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| Your Company Name: |
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| Type of Business Activity: |
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| Company's Tax ID |
Telephone
GPS
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| Your address: |
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| Address and GPS of water source if different then company: |
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| Brief description of water source to be evaluated including flow capacity per hour: |
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We , hereby do certify, that we have a legal access to the water source and officially granted, legal permission to use the water for the evaluation purposes. |
| YES
NO
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We are hereby applying for water Oxidation Reduction Potential evaluation, and certification based on true properties of the original water source above described. |
| YES
NO
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We are interested in water de-oxidation program based on the result of ORP evaluation. |
| YES
NO
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Please send us service agreement |
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