Phone : 606-256-4142
Fax : 606-256-2152
Email: Contact Us
HOME & OFFICE SIGN-UP FORM
INTERNET SIGN UP SPECIAL. Use the form below to sign up for our water service and get the first month cooler rental and 3 - 5 gallon bottles of our spring water free. All you pay for is bottle deposit on your first invoice.
What could be more convenient than having a fresh supply of bottled water delivered to your door every month? With Climax Waters delivery service, you get crisp, pure water in environmentally friendly 3-gallon or 5-gallon bottles. Complete the sign up form below and we will schedule a delivery to your home or office.
Contact Name (required)
Street Address (required)
City (required)
State & Zip (required)
Phone (required)
Fax
E-mail (required)
Start Date (if applicable):
Number of bottles
Do you need to rent a cooler?
Yes
No
Bottle Option
Include any of the following?
Cup Holder?
Cups
16 oz / 24 pack bottles
Detailed directions to your Home or Office
How did you hear about us?
Please be patient as files may take time to upload depending on the file size and your connection speed.
