FRESH AIR MACHINE
Please complete the following survey to receive your own fresh air machine absolutely FREE!  This fresh air machine (normally $159) helps with allergies, asthma, and breathing problems.  
No purchase necessary.  VA & WV residents only.
*subject to company rules & policy

Sign in to Google to save your progress. Learn more
RainMate® Fresh Air Machine
Introducing the RainMate® and Signature Fragrances
Who referred you to take this survey?  (First & Last Name) *
Do you believe the air quality has gotten better, gotten worse, or stayed the same in recent years? *
Does anyone in your household have any of the following *
Required
Do you have children or pets? *
Are you married or have a live in partner? *
What do you do for work? *
If applicable, what does your partner do for work?
Age Group *
Housing Status *
What is your approximate credit score? *
Your Name  (First & Last) *
Street Address *
City/Town *
State *
Phone Number *
Annual Household Income *
If selected, do you prefer to be contacted by call or text? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms