Water Filters
Please fill out the information below if you are in need of clean and safe water in your home. We prioritize those who don't have access to clean water within their home. The water filters are for you and your family and is not for cattle use.

We will get back with you in a week while we sort through applications. Thank you so much for applying!

We will close this application once we reach 50.  


Name *
Email
Physical Address *
Phone number *
Do you have piping/tap water in your home? *
Do you transport your water to your home? *
What do you use your water for? *
Required
Comments?
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