Customer Sign Up

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.

Company Name (required)

Contact Name (required)

Street Address (required)

City (required)

States (required)

Zip (required)

Phone (required)

Fax

E-mail (required)

Start Date (if applicable):

Number of bottles

Do you need to rent a cooler?
YesNo
Bottle Option

Include any of the following?
Cup Holder?Cups16 oz / 24 pack bottles

Detailed directions to your Home or Office

How did you hear about us?