Retail Warranty Card
Please fill out the form below. Fields marked with an astrisk (*) are required.

*First name
*Last name 
*Street Address
Appt. No.
*Zip Code
Price Paid excluding tax
and installation costs
$ Model Number       UPC Code can be found on your product packaging.
Date of Purchase   10 Digit UPC Code  

1. Is this your first Culligan purchase? yesno

2. Where this product was purchased?

3. Where you intend to purchase replacement filters?

4. How did you first become aware of this product? (Choose one)

  • Radio ad
  • TV ad
  • Newspaper ad/insert
  • Magazine review/article
  • Friend/relative
  • Web site/internet
  • Store display
  • Other

5. What factors most influenced your decision to buy a Culligan brand product over another brand? (Choose up to three)
  • Received as gift
  • Brand reputation
  • Previous experience with Culligan
  • Ease of installation
  • Style/appearance
  • Product availability
  • Warranty
  • Friend/relative recommendation
  • Value for the money

6. What influenced you most to buy a filter at this time? (Choose one)
  • To improve taste
  • To eliminate odors
  • To reduce chemicals/impurities
  • Medical/health reasons
  • New baby
  • Recent water quality concerns
  • Remodeled kitchen
  • Moved to new apt./home

7. Who did (or will do) most of the work to install this product?
  • No installation required
  • Self
  • Friend/relative
  • Professional installer

8. If installed, how easy or difficult was the installation of this product?
  • Unknown–installed by someone else
  • Very easy
  • Relatively easy
  • Somewhat difficult
  • Very difficult

9. What other brands did you seriously consider before making this purchase?
  • Brita
  • GE
  • Omni
  • Pur
  • Sears/Kenmore
  • Whirlpool
  • None
  • Other
 Specify Other:

10. Year of birth:          MaleFemale       Marital status:  MarriedSingle

11. For your primary residence, do you:

  • Rent
  • Own
  • Reside on college campus

12. Highest education level attained: (Choose one)
  • Completed high school
  • Some college/tech school
  • Completed college/tech school
  • Completed grad school

13. Family members in household:
 No. of adults 18 or older:   No. of children 8 to 12 years:    No. of children 0 to 2 years:   
No. of children 13 to 17 years:       No. of children 3 to 7 years:        

14. Would you be interested in receiving product information or special offers? yesno

15. Would you be interested in receiving an email reminder to replace your filter? yesno

16. Would you be interested in participating in a future research study? yesno