Thank you for considering responding to this survey evaluating your experience with PURE AQUA. Your answers will help us to deliver superior service and value by identifying those areas that require our additional attention. Completing this form should take from 5 to 10 minutes.

	* Required Fields
Name (Optional):
* Account Name:
Position:	First Line Mid-Management Senior
Function:	Engineering Environmental Maintenance Operations Production Purchasing Other
Region:	Africa Asia Australia Europe Middle East North America South America
Industry:	Administrative / R&D Services Air Separation & Industrial Gases Aircraft/Aerospace Alumina / Bauxite Aluminum - Primary Aluminum - Secondary Ammonia & Fertilization Production Assembly & Engine/Transmission Parts Automotive Assembly Automotive Parts - Miscellaneous Auto Pa Ceramics Coil - Aluminum Coil - Steel Construction Vehicles Copper Ore Downstream Terminal Additives Educational services Electrical Equipment Electronics Food & Beverage Fuel Additives Gas Gathering & Gas Plants General Manufacturing Gold / Silver Ores Government Government / Investor Owned Utility Health Services Heavy Trucks Hospitals Hotels Industrial Chemicals Industrial Minerals Ink/ Graphic Arts/Coatings Iron Ore Miscellaneous Primary Metals Municipalities Natural & Synthetic Fiber & Chips Oil Field Service/Extraction Petrochemicals Pharmaceutical Plastics Power Pulp & Paper Railcar/Railroad/Ships Refining Rubber Schools/Educational Steel - Foundry Steel - Integrated / Mini Mill. Textiles Tire Manufacturing Tobacco Transportation Services Wholesale/Retail/ Real Estate Other - Chemical Products Other- Mining & Mineral Processing Other
Location (City, State):
* E-Mail (Optional):

How important are the following areas to your business? Please answer using the rating scale where
5 means "extremely important" and 1 means "not important at all"
Our understanding of your business needs	Select 1 2 3 4 5 N/A
Our ability to provide solutions to your problems	Select 1 2 3 4 5 N/A
The representative(s) assigned to your account	Select 1 2 3 4 5 N/A
The response from the PURE AQUA Customer Care Center	Select 1 2 3 4 5 N/A
Value for the price	Select 1 2 3 4 5 N/A
PURE AQUA performance against your expectations	Select 1 2 3 4 5 N/A
Delivery of high quality products	Select 1 2 3 4 5 N/A
Delivery of the products when you want it	Select 1 2 3 4 5 N/A
My PURE AQUA representative(s) knows his/her products and their proper application	Select 1 2 3 4 5 N/A

How satisfied are you with PURE AQUA in the following areas? Please answer using the rating scale where
5 means "extremely satisfied" and 1 means "very unsatisfied"
Our understanding of your business needs	Select 1 2 3 4 5 N/A
Our ability to provide solutions to your problems	Select 1 2 3 4 5 N/A
The representative(s) assigned to your account	Select 1 2 3 4 5 N/A
The response from the PURE AQUA Customer Care Center	Select 1 2 3 4 5 N/A
Value for the price	Select 1 2 3 4 5/ N/A
PURE AQUA performance against your expectations	Select 1 2 3 4 5 N/A
Delivery of high quality products	Select 1 2 3 4 5 N/A
Delivery of the products when you want it	Select 1 2 3 4 5 N/A
Our use of the time we spend at your facility	Select 1 2 3 4 5 N/A
My PURE AQUA representative(s) knows his/her products and their proper application	Select 1 2 3 4 5 N/A

Please give us your response to the following questions
How long have you used PURE AQUA for your water and/or process treatment needs ?	Less than 1 year 1 to 3 years Over 3 years
What are the expected savings you would like to see from your water treatment supplier(s)?
What are the expected savings you realize today working with your water treatment supplier(s)?
What does PURE AQUA DO that most impacts your business?
What does PURE AQUA NOT DO that most impacts your business?
What supplier(s) do you currently use for your water treatment needs?
Are you considering to switch suppliers?	Yes      No
Would you like a PURE AQUA representative to contact you?	Yes      No
Is there anything you would like to tell PURE AQUA that was not already asked in the survey?
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