redriverculligan.com
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141.193.213.20
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Submitted URL: https://www.culliganoftexoma.com/
Effective URL: https://redriverculligan.com/
Submission: On October 12 via api from US — Scanned from US
Effective URL: https://redriverculligan.com/
Submission: On October 12 via api from US — Scanned from US
Form analysis 15 forms found in the DOM
GET /
<form action="/" method="GET"> <input type="text" name="s" placeholder="Search"> <button class="btn btn-sm nitro-lazy"><span class="visually-hidden nitro-lazy">Go</span></button> </form>GET /
<form action="/" method="GET"> <input type="text" name="s" placeholder="Search" class="lazyloaded"> <button class="btn btn-sm"><span class="visually-hidden">Go</span></button> </form>POST /#gf_18
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<div class="gf_invisible ginput_recaptchav3" data-sitekey="6LfuBiMeAAAAADCHf7nVcEWc7-S784CbyHFVmB1P" data-tabindex="0"><input id="input_e9301a9b755cafcbcb6cb71332ea7dc6" class="gfield_recaptcha_response" type="hidden"
name="input_e9301a9b755cafcbcb6cb71332ea7dc6" value=""></div>
<div class="gform-body gform_body">
<div id="gform_fields_18" class="gform_fields top_label form_sublabel_below description_below validation_below">
<div id="field_18_10"
class="gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half form-date-input gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_18_10"><label class="gfield_label gform-field-label" for="input_18_10">Date<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_date"> <input name="input_10" id="input_18_10" type="text" value="" class="datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon" placeholder="mm/dd/yyyy"
aria-describedby="input_18_10_date_format" aria-invalid="false" aria-required="true"> <span id="input_18_10_date_format" class="screen-reader-text">MM slash DD slash YYYY</span> </div> <input type="hidden"
id="gforms_calendar_icon_input_18_10" class="gform_hidden" value="https://redriverculligan.com/wp-content/plugins/gravityforms/images/datepicker/datepicker.svg">
</div>
<div id="field_18_11"
class="gfield gfield--type-select gfield--input-type-select gfield--width-quarter form-time-input gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_18_11"><label class="gfield_label gform-field-label" for="input_18_11">Time<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_11" id="input_18_11" class="large gfield_select" aria-required="true" aria-invalid="false">
<option value="9:00am">9:00am</option>
<option value="9:30am">9:30am</option>
<option value="10:00am">10:00am</option>
<option value="10:30am">10:30am</option>
<option value="11:00am">11:00am</option>
<option value="11:30am">11:30am</option>
<option value="12:00pm">12:00pm</option>
<option value="12:30pm">12:30pm</option>
<option value="1:00pm">1:00pm</option>
<option value="1:30pm">1:30pm</option>
<option value="2:00pm">2:00pm</option>
<option value="2:30pm">2:30pm</option>
<option value="3:00pm">3:00pm</option>
<option value="3:30pm">3:30pm</option>
<option value="4:00pm">4:00pm</option>
<option value="4:30pm">4:30pm</option>
<option value="5:00pm">5:00pm</option>
<option value="5:30pm">5:30pm</option>
<option value="6:00pm">6:00pm</option>
<option value="6:30pm">6:30pm</option>
<option value="7:00pm">7:00pm</option>
<option value="7:30pm">7:30pm</option>
</select></div>
</div>
<div id="field_18_1"
class="gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_18_1"><label class="gfield_label gform-field-label" for="input_18_1">First Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_1" id="input_18_1" type="text" value="" class="large" placeholder="First Name*" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_18_8"
class="gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_18_8"><label class="gfield_label gform-field-label" for="input_18_8">Last Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_8" id="input_18_8" type="text" value="" class="large" placeholder="Last Name*" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_18_4"
class="gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_18_4"><label class="gfield_label gform-field-label" for="input_18_4">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email"> <input name="input_4" id="input_18_4" type="email" value="" class="large" placeholder="Email*" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_18_5"
class="gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_18_5"><label class="gfield_label gform-field-label" for="input_18_5">Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_5" id="input_18_5" type="tel" value="" class="large" placeholder="Phone*" aria-required="true" aria-invalid="false"></div>
</div>
<div id="field_18_9" class="gfield gfield--type-text gfield--input-type-text gfield--width-two-thirds field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_18_9"><label class="gfield_label gform-field-label" for="input_18_9">Address</label>
<div class="ginput_container ginput_container_text"><input name="input_9" id="input_18_9" type="text" value="" class="large" placeholder="Address" aria-invalid="false"> </div>
</div>
<div id="field_18_6"
class="gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_18_6"><label class="gfield_label gform-field-label" for="input_18_6">ZIP Code<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_6" id="input_18_6" type="text" value="" class="large" placeholder="ZIP Code*" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_18_7" class="gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_18_7"><label class="gfield_label gform-field-label" for="input_18_7">Comments/Questions</label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_7" id="input_18_7" class="textarea small" placeholder="Comments/Questions" aria-invalid="false" rows="10" cols="50"></textarea></div>
</div>
<fieldset id="field_18_13"
class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_18_13">
<legend class="gfield_label gform-field-label">Are You A Homeowner?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_container ginput_container_radio">
<div class="gfield_radio" id="input_18_13">
<div class="gchoice gchoice_18_13_0"> <input class="gfield-choice-input" name="input_13" type="radio" value="Yes" id="choice_18_13_0" onchange="gformToggleRadioOther( this )"> <label for="choice_18_13_0" id="label_18_13_0"
class="gform-field-label gform-field-label--type-inline">Yes</label> </div>
<div class="gchoice gchoice_18_13_1"> <input class="gfield-choice-input" name="input_13" type="radio" value="No" id="choice_18_13_1" onchange="gformToggleRadioOther( this )"> <label for="choice_18_13_1" id="label_18_13_1"
class="gform-field-label gform-field-label--type-inline">No</label> </div>
</div>
</div>
</fieldset>
<fieldset id="field_18_14"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_18_14">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Products & Services You Are Interested In:</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_18_14">
<div class="gchoice gchoice_18_14_1"> <input class="gfield-choice-input" name="input_14.1" type="checkbox" value="Water Softener" id="choice_18_14_1"> <label for="choice_18_14_1" id="label_18_14_1"
class="gform-field-label gform-field-label--type-inline">Water Softener</label> </div>
<div class="gchoice gchoice_18_14_2"> <input class="gfield-choice-input" name="input_14.2" type="checkbox" value="Whole House Filtration" id="choice_18_14_2"> <label for="choice_18_14_2" id="label_18_14_2"
class="gform-field-label gform-field-label--type-inline">Whole House Filtration</label> </div>
<div class="gchoice gchoice_18_14_3"> <input class="gfield-choice-input" name="input_14.3" type="checkbox" value="Reverse Osmosis Drinking Water Systems" id="choice_18_14_3"> <label for="choice_18_14_3" id="label_18_14_3"
class="gform-field-label gform-field-label--type-inline">Reverse Osmosis Drinking Water Systems</label> </div>
<div class="gchoice gchoice_18_14_4"> <input class="gfield-choice-input" name="input_14.4" type="checkbox" value="Bottled Water Delivery" id="choice_18_14_4"> <label for="choice_18_14_4" id="label_18_14_4"
class="gform-field-label gform-field-label--type-inline">Bottled Water Delivery</label> </div>
<div class="gchoice gchoice_18_14_5"> <input class="gfield-choice-input" name="input_14.5" type="checkbox" value="Bottle-Free Coolers" id="choice_18_14_5"> <label for="choice_18_14_5" id="label_18_14_5"
class="gform-field-label gform-field-label--type-inline">Bottle-Free Coolers</label> </div>
<div class="gchoice gchoice_18_14_6"> <input class="gfield-choice-input" name="input_14.6" type="checkbox" value="Salt Delivery" id="choice_18_14_6"> <label for="choice_18_14_6" id="label_18_14_6"
class="gform-field-label gform-field-label--type-inline">Salt Delivery</label> </div>
</div>
</div>
</fieldset>
<fieldset id="field_18_12"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_18_12">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Contact Consent</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_18_12">
<div class="gchoice gchoice_18_12_1"> <input class="gfield-choice-input" name="input_12.1" type="checkbox"
value="I provide my express consent to Culligan Water to contact me via Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time." checked="checked"
id="choice_18_12_1" aria-describedby="gfield_description_18_12"> <label for="choice_18_12_1" id="label_18_12_1" class="gform-field-label gform-field-label--type-inline">I provide my express consent to Culligan Water to contact me via
Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time.</label> </div>
</div>
</div>
<div class="gfield_description" id="gfield_description_18_12">
<div style="position:relative;top:-.5rem;left:1.25rem;font-size:.8rem;"><a href="/privacy-policy" target="_blank">Privacy Policy</a> <a href="/terms-conditions" target="_blank">Terms & Conditions</a></div>
</div>
</fieldset>
</div>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_18" class="gform_button button" value="Submit"
onclick="if(window["gf_submitting_18"]){return false;} if( !jQuery("#gform_18")[0].checkValidity || jQuery("#gform_18")[0].checkValidity()){window["gf_submitting_18"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_18"]){return false;} if( !jQuery("#gform_18")[0].checkValidity || jQuery("#gform_18")[0].checkValidity()){window["gf_submitting_18"]=true;} jQuery("#gform_18").trigger("submit",[true]); }">
<input type="hidden" name="gform_ajax" value="form_id=18&title=&description=1&tabindex=0&theme=gravity-theme"> <input type="hidden" class="gform_hidden" name="is_submit_18" value="1"> <input type="hidden" class="gform_hidden"
name="gform_submit" value="18"> <input type="hidden" class="gform_hidden" name="gform_unique_id" value=""> <input type="hidden" class="gform_hidden" name="state_18"
value="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">
<input type="hidden" class="gform_hidden" name="gform_target_page_number_18" id="gform_target_page_number_18" value="0"> <input type="hidden" class="gform_hidden" name="gform_source_page_number_18" id="gform_source_page_number_18" value="1">
<input type="hidden" name="gform_field_values" value=""> </div>
<p style="display:none !important;" class="akismet-fields-container" data-prefix="ak_"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_1" name="ak_js"
value="150"><template data-nitro-marker-id="f7c77ab2022772e17edd517dfab38298-1"></template></p>
</form>POST
<form method="post" class="email-sign-up-form icon-block icon-block--email-sign-up">
<div class="icon-block__icon"> <img width="136" height="163" alt="Clean Water Playbook Ebook" sizes="(max-width: 136px) 100vw, 136px"
nitro-lazy-srcset="https://cdn-ilbojjb.nitrocdn.com/sazkiHTuKqfEOAYjvPiHDGvKmHfJjdVL/assets/images/optimized/redriverculligan.com/wp-content/uploads/2021/10/Clean-Water-Playbook.jpeg 136w, https://cdn-ilbojjb.nitrocdn.com/sazkiHTuKqfEOAYjvPiHDGvKmHfJjdVL/assets/images/optimized/redriverculligan.com/wp-content/uploads/2021/10/Clean-Water-Playbook-42x50.jpeg 42w"
nitro-lazy-src="https://cdn-ilbojjb.nitrocdn.com/sazkiHTuKqfEOAYjvPiHDGvKmHfJjdVL/assets/images/optimized/redriverculligan.com/wp-content/uploads/2021/10/Clean-Water-Playbook.jpeg" class="attachment-medium_large size-medium_large nitro-lazy"
decoding="async" nitro-lazy-empty="" id="MTYxNjo1MDg=-1" src="data:image/svg+xml;nitro-empty-id=MTYxNjo1MDg=-1;base64,PHN2ZyB2aWV3Qm94PSIwIDAgMTM2IDE2MyIgd2lkdGg9IjEzNiIgaGVpZ2h0PSIxNjMiIHhtbG5zPSJodHRwOi8vd3d3LnczLm9yZy8yMDAwL3N2ZyI+PC9zdmc+">
</div>
<div class="icon-block__content">
<header class="section-header">
<h2 class="section-header__kicker">E-Book</h2>
<h3 class="section-header__headline">Download The Clean Water Playbook!</h3>
</header> <input type="email" name="email" id="block-email-input-" class="form-control" placeholder="Email">
</div> <button type="submit" class="icon-block__button btn btn-secondary btn-responsive">Download</button>
</form>POST
<form method="post" class="email-sign-up-form" data-modal="email-sign-up-form-modal"> <label for="es_email" class="visually-hidden">Enter your email</label> <input type="email" name="email" id="es_email" placeholder="Enter your email here"
required=""> <button type="submit"> <span class="spinner-border spinner-border-sm" role="status" aria-hidden="true"></span> Download For Free! </button> </form>POST /#gf_19
<form method="post" enctype="multipart/form-data" target="gform_ajax_frame_19" id="gform_19" class="schedule-appointment-form" action="/#gf_19" data-formid="19" novalidate="">
<div class="gf_invisible ginput_recaptchav3" data-sitekey="6LfuBiMeAAAAADCHf7nVcEWc7-S784CbyHFVmB1P" data-tabindex="0"><input id="input_492ba12bcc4ffce170508c1dd23569db" class="gfield_recaptcha_response" type="hidden"
name="input_492ba12bcc4ffce170508c1dd23569db" value=""></div>
<div class="gform-body gform_body">
<div id="gform_fields_19" class="gform_fields top_label form_sublabel_below description_below validation_below">
<div id="field_19_10"
class="gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half form-date-input gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_19_10"><label class="gfield_label gform-field-label" for="input_19_10">Date<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_date"> <input name="input_10" id="input_19_10" type="text" value="" class="datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon" placeholder="mm/dd/yyyy"
aria-describedby="input_19_10_date_format" aria-invalid="false" aria-required="true"> <span id="input_19_10_date_format" class="screen-reader-text">MM slash DD slash YYYY</span> </div> <input type="hidden"
id="gforms_calendar_icon_input_19_10" class="gform_hidden" value="https://redriverculligan.com/wp-content/plugins/gravityforms/images/datepicker/datepicker.svg">
</div>
<div id="field_19_11"
class="gfield gfield--type-select gfield--input-type-select gfield--width-quarter form-time-input gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_19_11"><label class="gfield_label gform-field-label" for="input_19_11">Time<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_11" id="input_19_11" aria-required="true" aria-invalid="false" class="large gfield_select nitro-lazy">
<option value="9:00am">9:00am</option>
<option value="9:30am">9:30am</option>
<option value="10:00am">10:00am</option>
<option value="10:30am">10:30am</option>
<option value="11:00am">11:00am</option>
<option value="11:30am">11:30am</option>
<option value="12:00pm">12:00pm</option>
<option value="12:30pm">12:30pm</option>
<option value="1:00pm">1:00pm</option>
<option value="1:30pm">1:30pm</option>
<option value="2:00pm">2:00pm</option>
<option value="2:30pm">2:30pm</option>
<option value="3:00pm">3:00pm</option>
<option value="3:30pm">3:30pm</option>
<option value="4:00pm">4:00pm</option>
<option value="4:30pm">4:30pm</option>
<option value="5:00pm">5:00pm</option>
<option value="5:30pm">5:30pm</option>
<option value="6:00pm">6:00pm</option>
<option value="6:30pm">6:30pm</option>
<option value="7:00pm">7:00pm</option>
<option value="7:30pm">7:30pm</option>
</select></div>
</div>
<div id="field_19_1"
class="gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_19_1"><label class="gfield_label gform-field-label" for="input_19_1">First Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_1" id="input_19_1" type="text" value="" class="large" placeholder="First Name*" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_19_8"
class="gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_19_8"><label class="gfield_label gform-field-label" for="input_19_8">Last Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_8" id="input_19_8" type="text" value="" class="large" placeholder="Last Name*" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_19_4"
class="gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_19_4"><label class="gfield_label gform-field-label" for="input_19_4">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email"> <input name="input_4" id="input_19_4" type="email" value="" class="large" placeholder="Email*" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_19_5"
class="gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_19_5"><label class="gfield_label gform-field-label" for="input_19_5">Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_5" id="input_19_5" type="tel" value="" class="large" placeholder="Phone*" aria-required="true" aria-invalid="false"></div>
</div>
<div id="field_19_9" class="gfield gfield--type-text gfield--input-type-text gfield--width-two-thirds field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_19_9"><label class="gfield_label gform-field-label" for="input_19_9">Address</label>
<div class="ginput_container ginput_container_text"><input name="input_9" id="input_19_9" type="text" value="" class="large" placeholder="Address" aria-invalid="false"> </div>
</div>
<div id="field_19_6"
class="gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_19_6"><label class="gfield_label gform-field-label" for="input_19_6">ZIP Code<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_6" id="input_19_6" type="text" value="" class="large" placeholder="ZIP Code*" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_19_7" class="gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_19_7"><label class="gfield_label gform-field-label" for="input_19_7">Comments/Questions</label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_7" id="input_19_7" class="textarea small" placeholder="Comments/Questions" aria-invalid="false" rows="10" cols="50"></textarea></div>
</div>
<fieldset id="field_19_13"
class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_19_13">
<legend class="gfield_label gform-field-label">Are You A Homeowner?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_container ginput_container_radio">
<div class="gfield_radio" id="input_19_13">
<div class="gchoice gchoice_19_13_0"> <input class="gfield-choice-input" name="input_13" type="radio" value="Yes" id="choice_19_13_0" onchange="gformToggleRadioOther( this )"> <label for="choice_19_13_0" id="label_19_13_0"
class="gform-field-label gform-field-label--type-inline">Yes</label> </div>
<div class="gchoice gchoice_19_13_1"> <input class="gfield-choice-input" name="input_13" type="radio" value="No" id="choice_19_13_1" onchange="gformToggleRadioOther( this )"> <label for="choice_19_13_1" id="label_19_13_1"
class="gform-field-label gform-field-label--type-inline">No</label> </div>
</div>
</div>
</fieldset>
<fieldset id="field_19_14"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_19_14">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Products & Services You Are Interested In:</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_19_14">
<div class="gchoice gchoice_19_14_1"> <input class="gfield-choice-input" name="input_14.1" type="checkbox" value="Water Softener" id="choice_19_14_1"> <label for="choice_19_14_1" id="label_19_14_1"
class="gform-field-label gform-field-label--type-inline">Water Softener</label> </div>
<div class="gchoice gchoice_19_14_2"> <input class="gfield-choice-input" name="input_14.2" type="checkbox" value="Whole House Filtration" id="choice_19_14_2"> <label for="choice_19_14_2" id="label_19_14_2"
class="gform-field-label gform-field-label--type-inline">Whole House Filtration</label> </div>
<div class="gchoice gchoice_19_14_3"> <input class="gfield-choice-input" name="input_14.3" type="checkbox" value="Reverse Osmosis Drinking Water Systems" id="choice_19_14_3"> <label for="choice_19_14_3" id="label_19_14_3"
class="gform-field-label gform-field-label--type-inline">Reverse Osmosis Drinking Water Systems</label> </div>
<div class="gchoice gchoice_19_14_4"> <input class="gfield-choice-input" name="input_14.4" type="checkbox" value="Bottled Water Delivery" id="choice_19_14_4"> <label for="choice_19_14_4" id="label_19_14_4"
class="gform-field-label gform-field-label--type-inline">Bottled Water Delivery</label> </div>
<div class="gchoice gchoice_19_14_5"> <input class="gfield-choice-input" name="input_14.5" type="checkbox" value="Bottle-Free Coolers" id="choice_19_14_5"> <label for="choice_19_14_5" id="label_19_14_5"
class="gform-field-label gform-field-label--type-inline">Bottle-Free Coolers</label> </div>
<div class="gchoice gchoice_19_14_6"> <input class="gfield-choice-input" name="input_14.6" type="checkbox" value="Salt Delivery" id="choice_19_14_6"> <label for="choice_19_14_6" id="label_19_14_6"
class="gform-field-label gform-field-label--type-inline">Salt Delivery</label> </div>
</div>
</div>
</fieldset>
<fieldset id="field_19_12"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_19_12">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Contact Consent</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_19_12">
<div class="gchoice gchoice_19_12_1"> <input class="gfield-choice-input" name="input_12.1" type="checkbox"
value="I provide my express consent to Culligan Water to contact me via Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time." checked="checked"
id="choice_19_12_1" aria-describedby="gfield_description_19_12"> <label for="choice_19_12_1" id="label_19_12_1" class="gform-field-label gform-field-label--type-inline">I provide my express consent to Culligan Water to contact me via
Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time.</label> </div>
</div>
</div>
<div class="gfield_description" id="gfield_description_19_12">
<div style="position:relative;top:-.5rem;left:1.25rem;font-size:.8rem;"><a href="/privacy-policy" target="_blank">Privacy Policy</a> <a href="/terms-conditions" target="_blank">Terms & Conditions</a></div>
</div>
</fieldset>
</div>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_19" class="gform_button button" value="Submit"
onclick="if(window["gf_submitting_19"]){return false;} if( !jQuery("#gform_19")[0].checkValidity || jQuery("#gform_19")[0].checkValidity()){window["gf_submitting_19"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_19"]){return false;} if( !jQuery("#gform_19")[0].checkValidity || jQuery("#gform_19")[0].checkValidity()){window["gf_submitting_19"]=true;} jQuery("#gform_19").trigger("submit",[true]); }">
<input type="hidden" name="gform_ajax" value="form_id=19&title=&description=1&tabindex=0&theme=gravity-theme"> <input type="hidden" class="gform_hidden" name="is_submit_19" value="1"> <input type="hidden" class="gform_hidden"
name="gform_submit" value="19"> <input type="hidden" class="gform_hidden" name="gform_unique_id" value=""> <input type="hidden" class="gform_hidden" name="state_19"
value="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">
<input type="hidden" class="gform_hidden" name="gform_target_page_number_19" id="gform_target_page_number_19" value="0"> <input type="hidden" class="gform_hidden" name="gform_source_page_number_19" id="gform_source_page_number_19" value="1">
<input type="hidden" name="gform_field_values" value=""> </div>
<p style="display:none !important;" class="akismet-fields-container" data-prefix="ak_"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_2" name="ak_js"
value="182"><template data-nitro-marker-id="77c33c5fdfd4343a828b75f4857830ef-1"></template></p>
</form>POST /#gf_1
<form method="post" enctype="multipart/form-data" target="gform_ajax_frame_1" id="gform_1" class="get-pricing-form" action="/#gf_1" data-formid="1" novalidate="">
<div class="gf_invisible ginput_recaptchav3" data-sitekey="6LfuBiMeAAAAADCHf7nVcEWc7-S784CbyHFVmB1P" data-tabindex="0"><input id="input_2d7a60f2b919364ce096d6d4aeca9888" class="gfield_recaptcha_response" type="hidden"
name="input_2d7a60f2b919364ce096d6d4aeca9888" value=""></div>
<div class="gform-body gform_body">
<div id="gform_fields_1" class="gform_fields top_label form_sublabel_below description_below validation_below">
<fieldset id="field_1_1" class="gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_1_1">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Name<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_1_1"> <span id="input_1_1_3_container"
class="name_first gform-grid-col gform-grid-col--size-auto"> <input type="text" name="input_1.3" id="input_1_1_3" value="" aria-required="true" placeholder="First Name"> <label for="input_1_1_3"
class="gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text">First</label> </span> <span id="input_1_1_6_container" class="name_last gform-grid-col gform-grid-col--size-auto"> <input type="text"
name="input_1.6" id="input_1_1_6" value="" aria-required="true" placeholder="Last Name"> <label for="input_1_1_6" class="gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text">Last</label> </span> </div>
</fieldset>
<div id="field_1_2"
class="gfield gfield--type-email gfield--input-type-email gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_1_2"><label class="gfield_label gform-field-label" for="input_1_2">Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_email"> <input name="input_2" id="input_1_2" type="email" value="" class="large" placeholder="Email" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_1_3"
class="gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_1_3"><label class="gfield_label gform-field-label" for="input_1_3">Phone<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_3" id="input_1_3" type="tel" value="" class="large" placeholder="Phone" aria-required="true" aria-invalid="false"></div>
</div>
<div id="field_1_4"
class="gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_1_4"><label class="gfield_label gform-field-label" for="input_1_4">ZIP Code<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_4" id="input_1_4" type="text" value="" class="large" placeholder="ZIP Code" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_1_5" class="gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_1_5"><label class="gfield_label gform-field-label" for="input_1_5">Questions/Comments</label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_5" id="input_1_5" class="textarea small" placeholder="Questions/Comments" aria-invalid="false" rows="10" cols="50"></textarea></div>
</div>
<fieldset id="field_1_6"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_1_6">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Email Sign-Up</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_1_6">
<div class="gchoice gchoice_1_6_1"> <input class="gfield-choice-input" name="input_6.1" type="checkbox" value="Sign me up for special offers and related marketing communications from Culligan Water." checked="checked" id="choice_1_6_1">
<label for="choice_1_6_1" id="label_1_6_1" class="gform-field-label gform-field-label--type-inline">Sign me up for special offers and related marketing communications from Culligan Water.</label> </div>
</div>
</div>
</fieldset>
<fieldset id="field_1_7"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_1_7">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Contact Consent</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_1_7">
<div class="gchoice gchoice_1_7_1"> <input class="gfield-choice-input" name="input_7.1" type="checkbox"
value="I provide my express consent to Culligan Water to contact me via Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time." id="choice_1_7_1"
aria-describedby="gfield_description_1_7"> <label for="choice_1_7_1" id="label_1_7_1" class="gform-field-label gform-field-label--type-inline">I provide my express consent to Culligan Water to contact me via Phone, Email and/or SMS. I
understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time.</label> </div>
</div>
</div>
<div class="gfield_description" id="gfield_description_1_7">
<div style="position:relative;top:-.5rem;left:1.25rem;font-size:.8rem;"><a href="/privacy-policy" target="_blank">Privacy Policy</a> <a href="/terms-conditions" target="_blank">Terms & Conditions</a></div>
</div>
</fieldset>
</div>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_1" class="gform_button button" value="Get Pricing"
onclick="if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} jQuery("#gform_1").trigger("submit",[true]); }">
<input type="hidden" name="gform_ajax" value="form_id=1&title=&description=1&tabindex=0&theme=gravity-theme"> <input type="hidden" class="gform_hidden" name="is_submit_1" value="1"> <input type="hidden" class="gform_hidden"
name="gform_submit" value="1"> <input type="hidden" class="gform_hidden" name="gform_unique_id" value=""> <input type="hidden" class="gform_hidden" name="state_1"
value="WyJ7XCI3LjFcIjpcImQzZmExMWZjYjkyNWI3ZTJmNzUxY2MwZWFhOWE0MzY5XCJ9IiwiMzA4NTY2ZDAyNGQ3MjFkNzFlZmRkMjhlMzVjYmNmMzIiXQ=="> <input type="hidden" class="gform_hidden" name="gform_target_page_number_1" id="gform_target_page_number_1" value="0">
<input type="hidden" class="gform_hidden" name="gform_source_page_number_1" id="gform_source_page_number_1" value="1"> <input type="hidden" name="gform_field_values" value=""> </div>
<p style="display:none !important;" class="akismet-fields-container" data-prefix="ak_"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_3" name="ak_js" value="93"><template
data-nitro-marker-id="292b59865dbae53a4f6fd8e6a140ff1a-1"></template></p>
</form>POST /#gf_2
<form method="post" enctype="multipart/form-data" target="gform_ajax_frame_2" id="gform_2" action="/#gf_2" data-formid="2" novalidate="">
<div class="gf_invisible ginput_recaptchav3" data-sitekey="6LfuBiMeAAAAADCHf7nVcEWc7-S784CbyHFVmB1P" data-tabindex="0"><input id="input_eb9e6b8e87b4620ae0ba879e0d28e4c2" class="gfield_recaptcha_response" type="hidden"
name="input_eb9e6b8e87b4620ae0ba879e0d28e4c2" value=""></div>
<div class="gform-body gform_body">
<div id="gform_fields_2" class="gform_fields top_label form_sublabel_below description_below validation_below">
<div id="field_2_1" class="gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_2_1"><label class="gfield_label gform-field-label" for="input_2_1">Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_email"> <input name="input_1" id="input_2_1" type="email" value="" class="large" placeholder="Enter your email address" aria-required="true" aria-invalid="false"> </div>
</div>
<fieldset id="field_2_2"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_2_2">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Contact Consent</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_2_2">
<div class="gchoice gchoice_2_2_1"> <input class="gfield-choice-input" name="input_2.1" type="checkbox"
value="I provide my express consent to Culligan Water to contact me via Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time." checked="checked"
id="choice_2_2_1" aria-describedby="gfield_description_2_2"> <label for="choice_2_2_1" id="label_2_2_1" class="gform-field-label gform-field-label--type-inline">I provide my express consent to Culligan Water to contact me via Phone,
Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time.</label> </div>
</div>
</div>
<div class="gfield_description" id="gfield_description_2_2">
<div style="position:relative;top:-.5rem;left:1.25rem;font-size:.8rem;"><a href="/privacy-policy" target="_blank">Privacy Policy</a> <a href="/terms-conditions" target="_blank">Terms & Conditions</a></div>
</div>
</fieldset>
</div>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_2" class="gform_button button" value="Submit"
onclick="if(window["gf_submitting_2"]){return false;} if( !jQuery("#gform_2")[0].checkValidity || jQuery("#gform_2")[0].checkValidity()){window["gf_submitting_2"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_2"]){return false;} if( !jQuery("#gform_2")[0].checkValidity || jQuery("#gform_2")[0].checkValidity()){window["gf_submitting_2"]=true;} jQuery("#gform_2").trigger("submit",[true]); }">
<input type="hidden" name="gform_ajax" value="form_id=2&title=&description=1&tabindex=0&theme=gravity-theme"> <input type="hidden" class="gform_hidden" name="is_submit_2" value="1"> <input type="hidden" class="gform_hidden"
name="gform_submit" value="2"> <input type="hidden" class="gform_hidden" name="gform_unique_id" value=""> <input type="hidden" class="gform_hidden" name="state_2"
value="WyJ7XCIyLjFcIjpcImQzZmExMWZjYjkyNWI3ZTJmNzUxY2MwZWFhOWE0MzY5XCJ9IiwiNzIzYTliYjNiYjU0ZGEyZDcxY2EzNTFmMDVlYjE0NWMiXQ=="> <input type="hidden" class="gform_hidden" name="gform_target_page_number_2" id="gform_target_page_number_2" value="0">
<input type="hidden" class="gform_hidden" name="gform_source_page_number_2" id="gform_source_page_number_2" value="1"> <input type="hidden" name="gform_field_values" value=""> </div>
<p style="display:none !important;" class="akismet-fields-container" data-prefix="ak_"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_4" name="ak_js" value="31"><template
data-nitro-marker-id="76d40e9ddae9d3bb408202a9b2204e98-1"></template></p>
</form>POST /#gf_4
<form method="post" enctype="multipart/form-data" target="gform_ajax_frame_4" id="gform_4" class="get-pricing-form" action="/#gf_4" data-formid="4" novalidate="">
<div class="gf_invisible ginput_recaptchav3" data-sitekey="6LfuBiMeAAAAADCHf7nVcEWc7-S784CbyHFVmB1P" data-tabindex="0"><input id="input_b1d5f7a0c3a2154bb174a190015425ba" class="gfield_recaptcha_response" type="hidden"
name="input_b1d5f7a0c3a2154bb174a190015425ba" value=""></div>
<div class="gform-body gform_body">
<div id="gform_fields_4" class="gform_fields top_label form_sublabel_below description_below validation_below">
<div id="field_4_12"
class="gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_4_12">Please fill out the form below and a Culligan representative will contact you shortly with details. </div>
<div id="field_4_7"
class="gfield gfield--type-text gfield--input-type-adminonly_hidden gfield--width-third field_admin_only deal-name-input field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_administrative"
data-js-reload="field_4_7"><input name="input_7" id="input_4_7" class="gform_hidden" type="hidden" value="placeholder,area_of_interest=placeholder"></div>
<div id="field_4_13"
class="gfield gfield--type-text gfield--input-type-adminonly_hidden gfield--width-third field_admin_only area-of-interest-input field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_administrative"
data-js-reload="field_4_13"><input name="input_13" id="input_4_13" class="gform_hidden" type="hidden" value=""></div>
<div id="field_4_14"
class="gfield gfield--type-text gfield--input-type-adminonly_hidden gfield--width-third field_admin_only promo-applied-input field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_administrative"
data-js-reload="field_4_14"><input name="input_14" id="input_4_14" class="gform_hidden" type="hidden" value=""></div>
<fieldset id="field_4_1" class="gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_4_1">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Name<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_4_1"> <span id="input_4_1_3_container"
class="name_first gform-grid-col gform-grid-col--size-auto"> <input type="text" name="input_1.3" id="input_4_1_3" value="" aria-required="true" placeholder="First Name"> <label for="input_4_1_3"
class="gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text">First</label> </span> <span id="input_4_1_6_container" class="name_last gform-grid-col gform-grid-col--size-auto"> <input type="text"
name="input_1.6" id="input_4_1_6" value="" aria-required="true" placeholder="Last Name"> <label for="input_4_1_6" class="gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text">Last</label> </span> </div>
</fieldset>
<div id="field_4_2"
class="gfield gfield--type-email gfield--input-type-email gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_4_2"><label class="gfield_label gform-field-label" for="input_4_2">Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_email"> <input name="input_2" id="input_4_2" type="email" value="" class="large" placeholder="Email" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_4_3"
class="gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_4_3"><label class="gfield_label gform-field-label" for="input_4_3">Phone<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_3" id="input_4_3" type="tel" value="" class="large" placeholder="Phone" aria-required="true" aria-invalid="false"></div>
</div>
<div id="field_4_4"
class="gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_4_4"><label class="gfield_label gform-field-label" for="input_4_4">ZIP Code<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_4" id="input_4_4" type="text" value="" class="large" placeholder="ZIP Code" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_4_5" class="gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_4_5"><label class="gfield_label gform-field-label" for="input_4_5">Questions/Comments</label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_5" id="input_4_5" class="textarea small" placeholder="Questions/Comments" aria-invalid="false" rows="10" cols="50"></textarea></div>
</div>
<fieldset id="field_4_15" class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_4_15">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Email Sign-Up</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_4_15">
<div class="gchoice gchoice_4_15_1"> <input class="gfield-choice-input" name="input_15.1" type="checkbox" value="Sign me up for special offers and related marketing communications from Culligan Water." checked="checked"
id="choice_4_15_1"> <label for="choice_4_15_1" id="label_4_15_1" class="gform-field-label gform-field-label--type-inline">Sign me up for special offers and related marketing communications from Culligan Water.</label> </div>
</div>
</div>
</fieldset>
<fieldset id="field_4_16"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_4_16">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Contact Consent</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_4_16">
<div class="gchoice gchoice_4_16_1"> <input class="gfield-choice-input" name="input_16.1" type="checkbox"
value="I provide my express consent to Culligan Water to contact me via Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time." checked="checked"
id="choice_4_16_1" aria-describedby="gfield_description_4_16"> <label for="choice_4_16_1" id="label_4_16_1" class="gform-field-label gform-field-label--type-inline">I provide my express consent to Culligan Water to contact me via
Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time.</label> </div>
</div>
</div>
<div class="gfield_description" id="gfield_description_4_16">
<div style="position:relative;top:-.5rem;left:1.25rem;font-size:.8rem;"><a href="/privacy-policy" target="_blank">Privacy Policy</a> <a href="/terms-conditions" target="_blank">Terms & Conditions</a></div>
</div>
</fieldset>
</div>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_4" class="gform_button button" value="Get Deal"
onclick="if(window["gf_submitting_4"]){return false;} if( !jQuery("#gform_4")[0].checkValidity || jQuery("#gform_4")[0].checkValidity()){window["gf_submitting_4"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_4"]){return false;} if( !jQuery("#gform_4")[0].checkValidity || jQuery("#gform_4")[0].checkValidity()){window["gf_submitting_4"]=true;} jQuery("#gform_4").trigger("submit",[true]); }">
<input type="hidden" name="gform_ajax" value="form_id=4&title=&description=&tabindex=0&theme=gravity-theme"> <input type="hidden" class="gform_hidden" name="is_submit_4" value="1"> <input type="hidden" class="gform_hidden"
name="gform_submit" value="4"> <input type="hidden" class="gform_hidden" name="gform_unique_id" value=""> <input type="hidden" class="gform_hidden" name="state_4"
value="WyJ7XCIxNS4xXCI6XCJmYjhmMzNkMGEyMTUwYmQ1ZGY5MDAxNjAyNjNiOTc0NFwiLFwiMTYuMVwiOlwiZDNmYTExZmNiOTI1YjdlMmY3NTFjYzBlYWE5YTQzNjlcIn0iLCI2NzAyODM2YTAzNTA2ZmM2NDhlZjMwZTY1MTNhYmY3YSJd"> <input type="hidden" class="gform_hidden"
name="gform_target_page_number_4" id="gform_target_page_number_4" value="0"> <input type="hidden" class="gform_hidden" name="gform_source_page_number_4" id="gform_source_page_number_4" value="1"> <input type="hidden" name="gform_field_values"
value="deal=placeholder%2Carea_of_interest%3Dplaceholder"> </div>
<p style="display:none !important;" class="akismet-fields-container" data-prefix="ak_"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_5" name="ak_js"
value="213"><template data-nitro-marker-id="ea783daffe8bbb26682869b0d36b20d3-1"></template></p>
</form>POST /#gf_5
<form method="post" enctype="multipart/form-data" target="gform_ajax_frame_5" id="gform_5" class="schedule-appointment-form" action="/#gf_5" data-formid="5" novalidate="">
<div class="gf_invisible ginput_recaptchav3" data-sitekey="6LfuBiMeAAAAADCHf7nVcEWc7-S784CbyHFVmB1P" data-tabindex="0"><input id="input_0ccb4d249aa69678abf7b34cbc036139" class="gfield_recaptcha_response" type="hidden"
name="input_0ccb4d249aa69678abf7b34cbc036139" value=""></div>
<div class="gform-body gform_body">
<div id="gform_fields_5" class="gform_fields top_label form_sublabel_below description_below validation_below">
<div id="field_5_10"
class="gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_5_10">Fill out this form to schedule a home visit! Choose the time that works best for you and Culligan will be there - morning, noon, or night, weekends too! Fill out this form and a representative will contact you
shortly to confirm your date and time. If you are a Culligan customer who would like to schedule a service appointment <a href="https://redriverculligan.com/service-request/">click here.</a></div>
<div id="field_5_8"
class="gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half form-date-input pe-5 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_5_8"><label class="gfield_label gform-field-label" for="input_5_8">Date<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_date"> <input name="input_8" id="input_5_8" type="text" value="" class="datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon" placeholder="mm/dd/yyyy"
aria-describedby="input_5_8_date_format" aria-invalid="false" aria-required="true"> <span id="input_5_8_date_format" class="screen-reader-text">MM slash DD slash YYYY</span> </div> <input type="hidden" id="gforms_calendar_icon_input_5_8"
class="gform_hidden" value="https://redriverculligan.com/wp-content/plugins/gravityforms/images/datepicker/datepicker.svg">
</div>
<div id="field_5_11"
class="gfield gfield--type-select gfield--input-type-select gfield--width-quarter form-time-input gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_5_11"><label class="gfield_label gform-field-label" for="input_5_11">Time<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_11" id="input_5_11" class="large gfield_select" aria-required="true" aria-invalid="false">
<option value="9:00am">9:00am</option>
<option value="9:30am">9:30am</option>
<option value="10:00am">10:00am</option>
<option value="10:30am">10:30am</option>
<option value="11:00am">11:00am</option>
<option value="11:30am">11:30am</option>
<option value="12:00pm">12:00pm</option>
<option value="12:30pm">12:30pm</option>
<option value="1:00pm">1:00pm</option>
<option value="1:30pm">1:30pm</option>
<option value="2:00pm">2:00pm</option>
<option value="2:30pm">2:30pm</option>
<option value="3:00pm">3:00pm</option>
<option value="3:30pm">3:30pm</option>
<option value="4:00pm">4:00pm</option>
<option value="4:30pm">4:30pm</option>
<option value="5:00pm">5:00pm</option>
<option value="5:30pm">5:30pm</option>
<option value="6:00pm">6:00pm</option>
<option value="6:30pm">6:30pm</option>
<option value="7:00pm">7:00pm</option>
<option value="7:30pm">7:30pm</option>
</select></div>
</div>
<fieldset id="field_5_1" class="gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_5_1">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_5_1"> <span id="input_5_1_3_container"
class="name_first gform-grid-col gform-grid-col--size-auto"> <input type="text" name="input_1.3" id="input_5_1_3" value="" aria-required="true" placeholder="First Name"> <label for="input_5_1_3"
class="gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text">First</label> </span> <span id="input_5_1_6_container" class="name_last gform-grid-col gform-grid-col--size-auto"> <input type="text"
name="input_1.6" id="input_5_1_6" value="" aria-required="true" placeholder="Last Name"> <label for="input_5_1_6" class="gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text">Last</label> </span> </div>
</fieldset>
<div id="field_5_2"
class="gfield gfield--type-email gfield--input-type-email gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_5_2"><label class="gfield_label gform-field-label" for="input_5_2">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email"> <input name="input_2" id="input_5_2" type="email" value="" class="large" placeholder="Email" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_5_3"
class="gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_5_3"><label class="gfield_label gform-field-label" for="input_5_3">Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_3" id="input_5_3" type="tel" value="" class="large" placeholder="Phone" aria-required="true" aria-invalid="false"></div>
</div>
<div id="field_5_4"
class="gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_5_4"><label class="gfield_label gform-field-label" for="input_5_4">ZIP Code<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_4" id="input_5_4" type="text" value="" class="large" placeholder="ZIP Code" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_5_15"
class="gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_5_15"><label class="gfield_label gform-field-label" for="input_5_15">Address<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_15" id="input_5_15" type="text" value="" class="large" placeholder="Address" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_5_5" class="gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_5_5"><label class="gfield_label gform-field-label" for="input_5_5">Questions/Comments</label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_5" id="input_5_5" class="textarea small" placeholder="Questions/Comments" aria-invalid="false" rows="10" cols="50"></textarea></div>
</div>
<fieldset id="field_5_18"
class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_5_18">
<legend class="gfield_label gform-field-label">Are You A Homeowner?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_container ginput_container_radio">
<div class="gfield_radio" id="input_5_18">
<div class="gchoice gchoice_5_18_0"> <input class="gfield-choice-input" name="input_18" type="radio" value="Yes" id="choice_5_18_0" onchange="gformToggleRadioOther( this )"> <label for="choice_5_18_0" id="label_5_18_0"
class="gform-field-label gform-field-label--type-inline">Yes</label> </div>
<div class="gchoice gchoice_5_18_1"> <input class="gfield-choice-input" name="input_18" type="radio" value="No" id="choice_5_18_1" onchange="gformToggleRadioOther( this )"> <label for="choice_5_18_1" id="label_5_18_1"
class="gform-field-label gform-field-label--type-inline">No</label> </div>
</div>
</div>
</fieldset>
<fieldset id="field_5_17"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_5_17">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Products & Services You Are Interested In:</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_5_17">
<div class="gchoice gchoice_5_17_1"> <input class="gfield-choice-input" name="input_17.1" type="checkbox" value="Water Softener" id="choice_5_17_1"> <label for="choice_5_17_1" id="label_5_17_1"
class="gform-field-label gform-field-label--type-inline">Water Softener</label> </div>
<div class="gchoice gchoice_5_17_2"> <input class="gfield-choice-input" name="input_17.2" type="checkbox" value="Whole House Filtration" id="choice_5_17_2"> <label for="choice_5_17_2" id="label_5_17_2"
class="gform-field-label gform-field-label--type-inline">Whole House Filtration</label> </div>
<div class="gchoice gchoice_5_17_3"> <input class="gfield-choice-input" name="input_17.3" type="checkbox" value="Reverse Osmosis Drinking Water Systems" id="choice_5_17_3"> <label for="choice_5_17_3" id="label_5_17_3"
class="gform-field-label gform-field-label--type-inline">Reverse Osmosis Drinking Water Systems</label> </div>
<div class="gchoice gchoice_5_17_4"> <input class="gfield-choice-input" name="input_17.4" type="checkbox" value="Bottled Water Delivery" id="choice_5_17_4"> <label for="choice_5_17_4" id="label_5_17_4"
class="gform-field-label gform-field-label--type-inline">Bottled Water Delivery</label> </div>
<div class="gchoice gchoice_5_17_5"> <input class="gfield-choice-input" name="input_17.5" type="checkbox" value="Bottle-Free Coolers" id="choice_5_17_5"> <label for="choice_5_17_5" id="label_5_17_5"
class="gform-field-label gform-field-label--type-inline">Bottle-Free Coolers</label> </div>
<div class="gchoice gchoice_5_17_6"> <input class="gfield-choice-input" name="input_17.6" type="checkbox" value="Salt Delivery" id="choice_5_17_6"> <label for="choice_5_17_6" id="label_5_17_6"
class="gform-field-label gform-field-label--type-inline">Salt Delivery</label> </div>
</div>
</div>
</fieldset>
<fieldset id="field_5_14"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_5_14">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Email Sign Up</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_5_14">
<div class="gchoice gchoice_5_14_1"> <input class="gfield-choice-input" name="input_14.1" type="checkbox" value="Sign me up for special offers and related marketing communications from Culligan Water." checked="checked"
id="choice_5_14_1"> <label for="choice_5_14_1" id="label_5_14_1" class="gform-field-label gform-field-label--type-inline">Sign me up for special offers and related marketing communications from Culligan Water.</label> </div>
</div>
</div>
</fieldset>
<fieldset id="field_5_16"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_5_16">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Contact Consent</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_5_16">
<div class="gchoice gchoice_5_16_1"> <input class="gfield-choice-input" name="input_16.1" type="checkbox"
value="I provide my express consent to Culligan Water to contact me via Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time." id="choice_5_16_1"
aria-describedby="gfield_description_5_16"> <label for="choice_5_16_1" id="label_5_16_1" class="gform-field-label gform-field-label--type-inline">I provide my express consent to Culligan Water to contact me via Phone, Email and/or
SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time.</label> </div>
</div>
</div>
<div class="gfield_description" id="gfield_description_5_16">
<div style="position:relative;top:-.5rem;left:1.25rem;font-size:.8rem;"><a href="/privacy-policy" target="_blank">Privacy Policy</a> <a href="/terms-conditions" target="_blank">Terms & Conditions</a></div>
</div>
</fieldset>
</div>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_5" class="gform_button button" value="Schedule My Appointment"
onclick="if(window["gf_submitting_5"]){return false;} if( !jQuery("#gform_5")[0].checkValidity || jQuery("#gform_5")[0].checkValidity()){window["gf_submitting_5"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_5"]){return false;} if( !jQuery("#gform_5")[0].checkValidity || jQuery("#gform_5")[0].checkValidity()){window["gf_submitting_5"]=true;} jQuery("#gform_5").trigger("submit",[true]); }">
<input type="hidden" name="gform_ajax" value="form_id=5&title=&description=1&tabindex=0&theme=gravity-theme"> <input type="hidden" class="gform_hidden" name="is_submit_5" value="1"> <input type="hidden" class="gform_hidden"
name="gform_submit" value="5"> <input type="hidden" class="gform_hidden" name="gform_unique_id" value=""> <input type="hidden" class="gform_hidden" name="state_5"
value="WyJ7XCIxOFwiOltcIjU2OWJmYjgwNjlmYWRjNzhjN2MwYmRhZjYyODZiOGI3XCIsXCIzZmQyMzMxMGRiYmYxM2NmNGZiZjgxZWY0ZjUzNmNiZVwiXSxcIjE3LjFcIjpcImY5MzBmMzg4MGI3NDIzNjQyY2FhODY2NWVjZjA4Njc1XCIsXCIxNy4yXCI6XCI3NjEzMWU1YmE5ZmRkYmE4OTZkOTE4ODgxOGQyMDIyM1wiLFwiMTcuM1wiOlwiYjFmNzBmNjIwNjQ1MWJlZmM4MWQyZjdmMWExZTgxMDdcIixcIjE3LjRcIjpcIjAzZGY4N2MwZjMxYmE0ZDMzODhiZWE2NDZjMjcxNDlhXCIsXCIxNy41XCI6XCIzOGM1NTcyZTEzMDg5MmMwMTM1M2E2YWE4ZmJmYWQ2N1wiLFwiMTcuNlwiOlwiN2E5OGMzZGQ0NWY0OWZhNmE1ZmI0MGE0MDQ5ZjIyOTdcIixcIjE2LjFcIjpcImQzZmExMWZjYjkyNWI3ZTJmNzUxY2MwZWFhOWE0MzY5XCJ9IiwiODRlYjZkZThlYTE2ZGZlNWZiNTFkNjMwNGQzMTE4ZWQiXQ==">
<input type="hidden" class="gform_hidden" name="gform_target_page_number_5" id="gform_target_page_number_5" value="0"> <input type="hidden" class="gform_hidden" name="gform_source_page_number_5" id="gform_source_page_number_5" value="1"> <input
type="hidden" name="gform_field_values" value=""> </div>
<p style="display:none !important;" class="akismet-fields-container" data-prefix="ak_"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_6" name="ak_js"
value="137"><template data-nitro-marker-id="32b2bbb270446e71dfef1993b81984ce-1"></template></p>
</form>POST /#gf_6
<form method="post" enctype="multipart/form-data" target="gform_ajax_frame_6" id="gform_6" class="get-pricing-form" action="/#gf_6" data-formid="6" novalidate="">
<div class="gf_invisible ginput_recaptchav3" data-sitekey="6LfuBiMeAAAAADCHf7nVcEWc7-S784CbyHFVmB1P" data-tabindex="0"><input id="input_e5e3b1f4b28fc34530a842900157c22e" class="gfield_recaptcha_response" type="hidden"
name="input_e5e3b1f4b28fc34530a842900157c22e" value=""></div>
<div class="gform-body gform_body">
<div id="gform_fields_6" class="gform_fields top_label form_sublabel_below description_below validation_below">
<div id="field_6_6"
class="gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_6_6">Please fill out the form for a home or office assessment and a Culligan representative will contact you shortly with details. </div>
<fieldset id="field_6_1" class="gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_6_1">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Name<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_6_1"> <span id="input_6_1_3_container"
class="name_first gform-grid-col gform-grid-col--size-auto"> <input type="text" name="input_1.3" id="input_6_1_3" value="" aria-required="true" placeholder="First Name"> <label for="input_6_1_3"
class="gform-field-label gform-field-label--type-sub ">First</label> </span> <span id="input_6_1_6_container" class="name_last gform-grid-col gform-grid-col--size-auto"> <input type="text" name="input_1.6" id="input_6_1_6" value=""
aria-required="true" placeholder="Last Name"> <label for="input_6_1_6" class="gform-field-label gform-field-label--type-sub ">Last</label> </span> </div>
</fieldset>
<div id="field_6_2"
class="gfield gfield--type-email gfield--input-type-email gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_6_2"><label class="gfield_label gform-field-label" for="input_6_2">Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_email"> <input name="input_2" id="input_6_2" type="email" value="" class="large" placeholder="Email" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_6_3"
class="gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_6_3"><label class="gfield_label gform-field-label" for="input_6_3">Phone<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_3" id="input_6_3" type="tel" value="" class="large" placeholder="Phone" aria-required="true" aria-invalid="false"></div>
</div>
<div id="field_6_4"
class="gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_6_4"><label class="gfield_label gform-field-label" for="input_6_4">ZIP Code<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_4" id="input_6_4" type="text" value="" class="large" placeholder="ZIP Code" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_6_5" class="gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_6_5"><label class="gfield_label gform-field-label" for="input_6_5">Questions/Comments</label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_5" id="input_6_5" class="textarea small" placeholder="Questions/Comments" aria-invalid="false" rows="10" cols="50"></textarea></div>
</div>
<fieldset id="field_6_7"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_6_7">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Email Sign Up</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_6_7">
<div class="gchoice gchoice_6_7_1"> <input class="gfield-choice-input" name="input_7.1" type="checkbox" value="Sign me up for special offers and related marketing communications from Culligan Water." checked="checked" id="choice_6_7_1">
<label for="choice_6_7_1" id="label_6_7_1" class="gform-field-label gform-field-label--type-inline">Sign me up for special offers and related marketing communications from Culligan Water.</label> </div>
</div>
</div>
</fieldset>
<fieldset id="field_6_8"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_6_8">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Contact Consent</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_6_8">
<div class="gchoice gchoice_6_8_1"> <input class="gfield-choice-input" name="input_8.1" type="checkbox"
value="I provide my express consent to Culligan Water to contact me via Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time." checked="checked"
id="choice_6_8_1" aria-describedby="gfield_description_6_8"> <label for="choice_6_8_1" id="label_6_8_1" class="gform-field-label gform-field-label--type-inline">I provide my express consent to Culligan Water to contact me via Phone,
Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time.</label> </div>
</div>
</div>
<div class="gfield_description" id="gfield_description_6_8">
<div style="position:relative;top:-.5rem;left:1.25rem;font-size:.8rem;"><a href="/privacy-policy" target="_blank">Privacy Policy</a> <a href="/terms-conditions" target="_blank">Terms & Conditions</a></div>
</div>
</fieldset>
</div>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_6" class="gform_button button" value="Submit"
onclick="if(window["gf_submitting_6"]){return false;} if( !jQuery("#gform_6")[0].checkValidity || jQuery("#gform_6")[0].checkValidity()){window["gf_submitting_6"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_6"]){return false;} if( !jQuery("#gform_6")[0].checkValidity || jQuery("#gform_6")[0].checkValidity()){window["gf_submitting_6"]=true;} jQuery("#gform_6").trigger("submit",[true]); }">
<input type="hidden" name="gform_ajax" value="form_id=6&title=&description=1&tabindex=0&theme=gravity-theme"> <input type="hidden" class="gform_hidden" name="is_submit_6" value="1"> <input type="hidden" class="gform_hidden"
name="gform_submit" value="6"> <input type="hidden" class="gform_hidden" name="gform_unique_id" value=""> <input type="hidden" class="gform_hidden" name="state_6"
value="WyJ7XCI4LjFcIjpcImQzZmExMWZjYjkyNWI3ZTJmNzUxY2MwZWFhOWE0MzY5XCJ9IiwiODI0MDRhYjY4MWVkYzI0M2M5ODljZmI5NGM0OTg0MTAiXQ=="> <input type="hidden" class="gform_hidden" name="gform_target_page_number_6" id="gform_target_page_number_6" value="0">
<input type="hidden" class="gform_hidden" name="gform_source_page_number_6" id="gform_source_page_number_6" value="1"> <input type="hidden" name="gform_field_values" value=""> </div>
<p style="display:none !important;" class="akismet-fields-container" data-prefix="ak_"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_7" name="ak_js"
value="216"><template data-nitro-marker-id="9b62088903d2791d85e73724fb453f8f-1"></template></p>
</form>POST /#gf_13
<form method="post" enctype="multipart/form-data" target="gform_ajax_frame_13" id="gform_13" class="get-pricing-form" action="/#gf_13" data-formid="13" novalidate="">
<div class="gf_invisible ginput_recaptchav3" data-sitekey="6LfuBiMeAAAAADCHf7nVcEWc7-S784CbyHFVmB1P" data-tabindex="0"><input id="input_f0f979ac39cfb1adbcbbd07077fac107" class="gfield_recaptcha_response" type="hidden"
name="input_f0f979ac39cfb1adbcbbd07077fac107" value=""></div>
<div class="gform-body gform_body">
<div id="gform_fields_13" class="gform_fields top_label form_sublabel_below description_below validation_below">
<fieldset id="field_13_1" class="gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_13_1">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Name<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_13_1"> <span id="input_13_1_3_container"
class="name_first gform-grid-col gform-grid-col--size-auto"> <input type="text" name="input_1.3" id="input_13_1_3" value="" aria-required="true" placeholder="First Name"> <label for="input_13_1_3"
class="gform-field-label gform-field-label--type-sub ">First</label> </span> <span id="input_13_1_6_container" class="name_last gform-grid-col gform-grid-col--size-auto"> <input type="text" name="input_1.6" id="input_13_1_6" value=""
aria-required="true" placeholder="Last Name"> <label for="input_13_1_6" class="gform-field-label gform-field-label--type-sub ">Last</label> </span> </div>
</fieldset>
<div id="field_13_2"
class="gfield gfield--type-email gfield--input-type-email gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_13_2"><label class="gfield_label gform-field-label" for="input_13_2">Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_email"> <input name="input_2" id="input_13_2" type="email" value="" class="large" placeholder="Email" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_13_3"
class="gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_13_3"><label class="gfield_label gform-field-label" for="input_13_3">Phone<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_3" id="input_13_3" type="tel" value="" class="large" placeholder="Phone" aria-required="true" aria-invalid="false"></div>
</div>
<div id="field_13_4"
class="gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_13_4"><label class="gfield_label gform-field-label" for="input_13_4">ZIP Code<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_4" id="input_13_4" type="text" value="" class="large" placeholder="ZIP Code" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_13_5" class="gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_13_5"><label class="gfield_label gform-field-label" for="input_13_5">Questions/Comments</label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_5" id="input_13_5" class="textarea small" placeholder="Questions/Comments" aria-invalid="false" rows="10" cols="50"></textarea></div>
</div>
<fieldset id="field_13_6"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_13_6">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Email Sign Up</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_13_6">
<div class="gchoice gchoice_13_6_1"> <input class="gfield-choice-input" name="input_6.1" type="checkbox" value="Sign me up for special offers and related marketing communications from Culligan Water." checked="checked" id="choice_13_6_1">
<label for="choice_13_6_1" id="label_13_6_1" class="gform-field-label gform-field-label--type-inline">Sign me up for special offers and related marketing communications from Culligan Water.</label> </div>
</div>
</div>
</fieldset>
<fieldset id="field_13_7"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_13_7">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Contact Consent</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_13_7">
<div class="gchoice gchoice_13_7_1"> <input class="gfield-choice-input" name="input_7.1" type="checkbox"
value="I provide my express consent to Culligan Water to contact me via Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time." checked="checked"
id="choice_13_7_1" aria-describedby="gfield_description_13_7"> <label for="choice_13_7_1" id="label_13_7_1" class="gform-field-label gform-field-label--type-inline">I provide my express consent to Culligan Water to contact me via
Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time.</label> </div>
</div>
</div>
<div class="gfield_description" id="gfield_description_13_7">
<div style="position:relative;top:-.5rem;left:1.25rem;font-size:.8rem;"><a href="/privacy-policy" target="_blank">Privacy Policy</a> <a href="/terms-conditions" target="_blank">Terms & Conditions</a></div>
</div>
</fieldset>
</div>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_13" class="gform_button button" value="Get Pricing"
onclick="if(window["gf_submitting_13"]){return false;} if( !jQuery("#gform_13")[0].checkValidity || jQuery("#gform_13")[0].checkValidity()){window["gf_submitting_13"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_13"]){return false;} if( !jQuery("#gform_13")[0].checkValidity || jQuery("#gform_13")[0].checkValidity()){window["gf_submitting_13"]=true;} jQuery("#gform_13").trigger("submit",[true]); }">
<input type="hidden" name="gform_ajax" value="form_id=13&title=&description=1&tabindex=0&theme=gravity-theme"> <input type="hidden" class="gform_hidden" name="is_submit_13" value="1"> <input type="hidden" class="gform_hidden"
name="gform_submit" value="13"> <input type="hidden" class="gform_hidden" name="gform_unique_id" value=""> <input type="hidden" class="gform_hidden" name="state_13"
value="WyJ7XCI3LjFcIjpcImQzZmExMWZjYjkyNWI3ZTJmNzUxY2MwZWFhOWE0MzY5XCJ9IiwiMzA4NTY2ZDAyNGQ3MjFkNzFlZmRkMjhlMzVjYmNmMzIiXQ=="> <input type="hidden" class="gform_hidden" name="gform_target_page_number_13" id="gform_target_page_number_13"
value="0"> <input type="hidden" class="gform_hidden" name="gform_source_page_number_13" id="gform_source_page_number_13" value="1"> <input type="hidden" name="gform_field_values" value=""> </div>
<p style="display:none !important;" class="akismet-fields-container" data-prefix="ak_"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_8" name="ak_js"
value="177"><template data-nitro-marker-id="13606009e4480b84d980755bb1c29389-1"></template></p>
</form>POST /#gf_14
<form method="post" enctype="multipart/form-data" target="gform_ajax_frame_14" id="gform_14" action="/#gf_14" data-formid="14" novalidate="">
<div class="gf_invisible ginput_recaptchav3" data-sitekey="6LfuBiMeAAAAADCHf7nVcEWc7-S784CbyHFVmB1P" data-tabindex="0"><input id="input_4d0835a63274b076f17a9ea463ec00ee" class="gfield_recaptcha_response" type="hidden"
name="input_4d0835a63274b076f17a9ea463ec00ee" value=""></div>
<div class="gform-body gform_body">
<div id="gform_fields_14" class="gform_fields top_label form_sublabel_below description_below validation_below">
<div id="field_14_10"
class="gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_14_10">Fill out this form to schedule a phone Q&A with us, and a Culligan representative will contact you!</div>
<div id="field_14_8"
class="gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half form-date-input pe-5 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_14_8"><label class="gfield_label gform-field-label" for="input_14_8">Date<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_date"> <input name="input_8" id="input_14_8" type="text" value="" class="datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon" placeholder="mm/dd/yyyy"
aria-describedby="input_14_8_date_format" aria-invalid="false" aria-required="true"> <span id="input_14_8_date_format" class="screen-reader-text">MM slash DD slash YYYY</span> </div> <input type="hidden"
id="gforms_calendar_icon_input_14_8" class="gform_hidden" value="https://redriverculligan.com/wp-content/plugins/gravityforms/images/datepicker/datepicker.svg">
</div>
<div id="field_14_11"
class="gfield gfield--type-select gfield--input-type-select gfield--width-quarter form-time-input gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_14_11"><label class="gfield_label gform-field-label" for="input_14_11">Time<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_11" id="input_14_11" class="large gfield_select" aria-required="true" aria-invalid="false">
<option value="8:00am">8:00am</option>
<option value="8:30am">8:30am</option>
<option value="9:00am">9:00am</option>
<option value="9:30am">9:30am</option>
<option value="10:00am">10:00am</option>
<option value="10:30am">10:30am</option>
<option value="11:00am">11:00am</option>
<option value="11:30am">11:30am</option>
<option value="12:00pm">12:00pm</option>
<option value="12:30pm">12:30pm</option>
<option value="1:00pm">1:00pm</option>
<option value="1:30pm">1:30pm</option>
<option value="2:00pm">2:00pm</option>
<option value="2:30pm">2:30pm</option>
<option value="3:00pm">3:00pm</option>
<option value="3:30pm">3:30pm</option>
<option value="4:00pm">4:00pm</option>
<option value="4:30pm">4:30pm</option>
<option value="5:00pm">5:00pm</option>
<option value="5:30pm">5:30pm</option>
<option value="6:00pm">6:00pm</option>
<option value="6:30pm">6:30pm</option>
<option value="7:00pm">7:00pm</option>
</select></div>
</div>
<fieldset id="field_14_1" class="gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_14_1">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Name<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_14_1"> <span id="input_14_1_3_container"
class="name_first gform-grid-col gform-grid-col--size-auto"> <input type="text" name="input_1.3" id="input_14_1_3" value="" aria-required="true" placeholder="First Name"> <label for="input_14_1_3"
class="gform-field-label gform-field-label--type-sub ">First</label> </span> <span id="input_14_1_6_container" class="name_last gform-grid-col gform-grid-col--size-auto"> <input type="text" name="input_1.6" id="input_14_1_6" value=""
aria-required="true" placeholder="Last Name"> <label for="input_14_1_6" class="gform-field-label gform-field-label--type-sub ">Last</label> </span> </div>
</fieldset>
<div id="field_14_2"
class="gfield gfield--type-email gfield--input-type-email gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_14_2"><label class="gfield_label gform-field-label" for="input_14_2">Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_email"> <input name="input_2" id="input_14_2" type="email" value="" class="large" placeholder="Email" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_14_3"
class="gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_14_3"><label class="gfield_label gform-field-label" for="input_14_3">Phone<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_3" id="input_14_3" type="tel" value="" class="large" placeholder="Phone" aria-required="true" aria-invalid="false"></div>
</div>
<div id="field_14_4"
class="gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_14_4"><label class="gfield_label gform-field-label" for="input_14_4">ZIP Code<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_4" id="input_14_4" type="text" value="" class="large" placeholder="ZIP Code" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_14_5" class="gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_14_5"><label class="gfield_label gform-field-label" for="input_14_5">Questions/Comments</label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_5" id="input_14_5" class="textarea small" placeholder="Questions/Comments" aria-invalid="false" rows="10" cols="50"></textarea></div>
</div>
<fieldset id="field_14_14"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_14_14">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Contact Consent</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_14_14">
<div class="gchoice gchoice_14_14_1"> <input class="gfield-choice-input" name="input_14.1" type="checkbox"
value="I provide my express consent to Culligan Water to contact me via Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time." checked="checked"
id="choice_14_14_1" aria-describedby="gfield_description_14_14"> <label for="choice_14_14_1" id="label_14_14_1" class="gform-field-label gform-field-label--type-inline">I provide my express consent to Culligan Water to contact me via
Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time.</label> </div>
</div>
</div>
<div class="gfield_description" id="gfield_description_14_14">
<div style="position:relative;top:-.5rem;left:1.25rem;font-size:.8rem;"><a href="/privacy-policy" target="_blank">Privacy Policy</a> <a href="/terms-conditions" target="_blank">Terms & Conditions</a></div>
</div>
</fieldset>
</div>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_14" class="gform_button button" value="Schedule My Appointment"
onclick="if(window["gf_submitting_14"]){return false;} if( !jQuery("#gform_14")[0].checkValidity || jQuery("#gform_14")[0].checkValidity()){window["gf_submitting_14"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_14"]){return false;} if( !jQuery("#gform_14")[0].checkValidity || jQuery("#gform_14")[0].checkValidity()){window["gf_submitting_14"]=true;} jQuery("#gform_14").trigger("submit",[true]); }">
<input type="hidden" name="gform_ajax" value="form_id=14&title=&description=1&tabindex=0&theme=gravity-theme"> <input type="hidden" class="gform_hidden" name="is_submit_14" value="1"> <input type="hidden" class="gform_hidden"
name="gform_submit" value="14"> <input type="hidden" class="gform_hidden" name="gform_unique_id" value=""> <input type="hidden" class="gform_hidden" name="state_14"
value="WyJ7XCIxNC4xXCI6XCJkM2ZhMTFmY2I5MjViN2UyZjc1MWNjMGVhYTlhNDM2OVwifSIsImY1Yzk1ZWQxNDQzMDViNzUwZWY0MWY5YWFlYmE0YWIyIl0="> <input type="hidden" class="gform_hidden" name="gform_target_page_number_14" id="gform_target_page_number_14"
value="0"> <input type="hidden" class="gform_hidden" name="gform_source_page_number_14" id="gform_source_page_number_14" value="1"> <input type="hidden" name="gform_field_values" value=""> </div>
<p style="display:none !important;" class="akismet-fields-container" data-prefix="ak_"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_9" name="ak_js"
value="164"><template data-nitro-marker-id="382b1a5604a1894d33280bea15236623-1"></template></p>
</form>POST /#gf_17
<form method="post" enctype="multipart/form-data" target="gform_ajax_frame_17" id="gform_17" class="get-pricing-form" action="/#gf_17" data-formid="17" novalidate="">
<div class="gf_invisible ginput_recaptchav3" data-sitekey="6LfuBiMeAAAAADCHf7nVcEWc7-S784CbyHFVmB1P" data-tabindex="0"><input id="input_784ebdb8aa148a43151bf5e7ff344698" class="gfield_recaptcha_response" type="hidden"
name="input_784ebdb8aa148a43151bf5e7ff344698" value=""></div>
<div class="gform-body gform_body">
<div id="gform_fields_17" class="gform_fields top_label form_sublabel_below description_below validation_below">
<div id="field_17_7"
class="gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"
data-js-reload="field_17_7">
<h2 class="h3">Try Culligan For Less Than $1/day!</h2>
<p>Try before you buy! Rent a Culligan water softener or reverse osmosis system for $9.95/mo. for the first three months! Fill out the form below and a Culligan representative will contact you shortly with details.</p>
</div>
<fieldset id="field_17_1" class="gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_17_1">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Name<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_17_1"> <span id="input_17_1_3_container"
class="name_first gform-grid-col gform-grid-col--size-auto"> <input type="text" name="input_1.3" id="input_17_1_3" value="" aria-required="true" placeholder="First Name"> <label for="input_17_1_3"
class="gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text">First</label> </span> <span id="input_17_1_6_container" class="name_last gform-grid-col gform-grid-col--size-auto"> <input type="text"
name="input_1.6" id="input_17_1_6" value="" aria-required="true" placeholder="Last Name"> <label for="input_17_1_6" class="gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text">Last</label> </span> </div>
</fieldset>
<div id="field_17_2"
class="gfield gfield--type-email gfield--input-type-email gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_17_2"><label class="gfield_label gform-field-label" for="input_17_2">Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_email"> <input name="input_2" id="input_17_2" type="email" value="" class="large" placeholder="Email" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_17_3"
class="gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_17_3"><label class="gfield_label gform-field-label" for="input_17_3">Phone<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_3" id="input_17_3" type="tel" value="" class="large" placeholder="Phone" aria-required="true" aria-invalid="false"></div>
</div>
<div id="field_17_4"
class="gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_17_4"><label class="gfield_label gform-field-label" for="input_17_4">ZIP Code<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_4" id="input_17_4" type="text" value="" class="large" placeholder="ZIP Code" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_17_5" class="gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_17_5"><label class="gfield_label gform-field-label" for="input_17_5">Questions/Comments</label>
<div class="ginput_container ginput_container_textarea"><textarea name="input_5" id="input_17_5" class="textarea small" placeholder="Questions/Comments" aria-invalid="false" rows="10" cols="50"></textarea></div>
</div>
<fieldset id="field_17_6"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_17_6">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Email Sign-Up</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_17_6">
<div class="gchoice gchoice_17_6_1"> <input class="gfield-choice-input" name="input_6.1" type="checkbox" value="Sign me up for special offers and related marketing communications from Culligan Water." checked="checked" id="choice_17_6_1">
<label for="choice_17_6_1" id="label_17_6_1" class="gform-field-label gform-field-label--type-inline">Sign me up for special offers and related marketing communications from Culligan Water.</label> </div>
</div>
</div>
</fieldset>
<fieldset id="field_17_8"
class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_17_8">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Contact Consent</legend>
<div class="ginput_container ginput_container_checkbox">
<div class="gfield_checkbox" id="input_17_8">
<div class="gchoice gchoice_17_8_1"> <input class="gfield-choice-input" name="input_8.1" type="checkbox"
value="I provide my express consent to Culligan Water to contact me via Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time." checked="checked"
id="choice_17_8_1" aria-describedby="gfield_description_17_8"> <label for="choice_17_8_1" id="label_17_8_1" class="gform-field-label gform-field-label--type-inline">I provide my express consent to Culligan Water to contact me via
Phone, Email and/or SMS. I understand that my consent is not a requirement for purchase, and I may withdraw my consent at any time.</label> </div>
</div>
</div>
<div class="gfield_description" id="gfield_description_17_8">
<div style="position:relative;top:-.5rem;left:1.25rem;font-size:.8rem;"><a href="/privacy-policy" target="_blank">Privacy Policy</a> <a href="/terms-conditions" target="_blank">Terms & Conditions</a></div>
</div>
</fieldset>
</div>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_17" class="gform_button button" value="Get Pricing"
onclick="if(window["gf_submitting_17"]){return false;} if( !jQuery("#gform_17")[0].checkValidity || jQuery("#gform_17")[0].checkValidity()){window["gf_submitting_17"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_17"]){return false;} if( !jQuery("#gform_17")[0].checkValidity || jQuery("#gform_17")[0].checkValidity()){window["gf_submitting_17"]=true;} jQuery("#gform_17").trigger("submit",[true]); }">
<input type="hidden" name="gform_ajax" value="form_id=17&title=&description=1&tabindex=0&theme=gravity-theme"> <input type="hidden" class="gform_hidden" name="is_submit_17" value="1"> <input type="hidden" class="gform_hidden"
name="gform_submit" value="17"> <input type="hidden" class="gform_hidden" name="gform_unique_id" value=""> <input type="hidden" class="gform_hidden" name="state_17"
value="WyJ7XCI4LjFcIjpcImQzZmExMWZjYjkyNWI3ZTJmNzUxY2MwZWFhOWE0MzY5XCJ9IiwiODI0MDRhYjY4MWVkYzI0M2M5ODljZmI5NGM0OTg0MTAiXQ=="> <input type="hidden" class="gform_hidden" name="gform_target_page_number_17" id="gform_target_page_number_17"
value="0"> <input type="hidden" class="gform_hidden" name="gform_source_page_number_17" id="gform_source_page_number_17" value="1"> <input type="hidden" name="gform_field_values" value=""> </div>
<p style="display:none !important;" class="akismet-fields-container" data-prefix="ak_"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_10" name="ak_js" value="0"><template
data-nitro-marker-id="0cc1800c5806e4d7372847647ec19e33-1"></template></p>
</form>POST /#gf_20
<form method="post" enctype="multipart/form-data" target="gform_ajax_frame_20" id="gform_20" class="get-pricing-form" action="/#gf_20" data-formid="20" novalidate="">
<div class="gf_invisible ginput_recaptchav3" data-sitekey="6LfuBiMeAAAAADCHf7nVcEWc7-S784CbyHFVmB1P" data-tabindex="0"><input id="input_f020b3b1c4b9b3d41272c6c74a01c1bc" class="gfield_recaptcha_response" type="hidden"
name="input_f020b3b1c4b9b3d41272c6c74a01c1bc" value=""></div>
<div class="gform-body gform_body">
<div id="gform_fields_20" class="gform_fields top_label form_sublabel_below description_below validation_below">
<fieldset id="field_20_1" class="gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_20_1">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Name<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_20_1"> <span id="input_20_1_3_container"
class="name_first gform-grid-col gform-grid-col--size-auto"> <input type="text" name="input_1.3" id="input_20_1_3" value="" aria-required="true" placeholder="First Name"> <label for="input_20_1_3"
class="gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text">First</label> </span> <span id="input_20_1_6_container" class="name_last gform-grid-col gform-grid-col--size-auto"> <input type="text"
name="input_1.6" id="input_20_1_6" value="" aria-required="true" placeholder="Last Name"> <label for="input_20_1_6" class="gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text">Last</label> </span> </div>
</fieldset>
<div id="field_20_8" class="gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_20_8"><label class="gfield_label gform-field-label screen-reader-text" for="input_20_8">Business</label>
<div class="ginput_container ginput_container_text"><input name="input_8" id="input_20_8" type="text" value="" class="large" placeholder="Business" aria-invalid="false"> </div>
</div>
<div id="field_20_2"
class="gfield gfield--type-email gfield--input-type-email gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
data-js-reload="field_20_2"><label class="gfield_label gform-field-label" for="input_20_2">Email<span class="gfield_required"><span class="gfield_required gfield_required_text">(Required)</span></span></label>
<div class="ginput_container ginput_container_email"> <input name="input_2" id="input_20_2" type="email" value="" class="large" placeholder="Email" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_20_3"
class="gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible"
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DENISON & SHERMAN’S HOME FOR BETTER WATER
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Locally Owned and Operated Proudly Serving: Grayson, Sherman, Cook, Fannin,
Bryan,
Pottsboro, and Choctaw County
SHOP
OUR PRODUCTS
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FREE INSTALLATION (UP TO $500 VALUE)
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Get Deal Today
TRADE IN YOUR OLD SOFTENER – UP TO $400 VALUE!
For a NEW Culligan High-Efficiency Water Softener.
Get Deal Today
THE PROOF
WHY DO DENISON & SHERMAN
HOMEOWNERS LOVE US?
“Water tastes so good since the entire house got Culligan water filter.
Great customer service. Chad K. is such a nice and professional worker. Strongly
recommend this company if you need to install water filters!
– Q.L.
“We have had Culligan Reverse Osmosis equipment and water softeners since 1995.
Wonderful products and great service from a nationally known company.
They also have bottle water delivery for those that do not want the under sink
drinking water units. You cannot go wrong with a water company that has such an
awesome background.
– Linda F.
“My hair has never been softer and the water is pure enough to drink.
We recently installed Culligan into our home and we are loving it. The tech
helped us set up the app…Lets you know if you have water on while you’re away.
Plus, it will let you know how much water you are using.
– Dawn C.
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WHY CULLIGAN?
* No third-party installation. No big box retailers. Full-Service high-quality
water from a local, family-owned business that has been serving the DFW since
1947.
* Customized to fit YOUR water needs. Your neighbor’s home, your parents’ home
across town — their home water situation may be very different from yours.
Culligan works for your tap, your family, your home
* Security: 30-day money-back guarantee. Limited 20 year warranty. No shipping
damage worries, no restocking fees!
FOREVER CHEMICALS IN DENISON & SHERMAN DRINKING WATER
Polyfluorinated alkyl substances (PFAS), also known as ‘Forever Chemicals’ have
been found in the tap water of various locations across the United States,
including parts of the Denison & Sherman Area. There is concern about potential
exposure and its long-term effects on public health.
PFAS are persistent chemicals that can accumulate in the human body over time
through exposure to contaminated water, food, or air. These substances have been
linked to various health issues, including liver damage, immune system
disruption, thyroid disorders, and an increased risk of certain cancers.
Learn More
COMMERCIAL & INDUSTRIAL
ARE YOU LOSING OPERATIONAL COSTS BECAUSE OF POOR WATER QUALITY OR TREATMENT
EQUIPMENT?
Learn More
* Deionization
* Industrial Softening
* Large Scale Filtration/RO
* Pre-Treatment
* Storage/Distribution
* Reclamation/Re-Use
DENISON & SHERMAN WATER PROBLEMS?
WE HAVE
ANSWERS!
Check Out Our Solution Center
E-BOOK
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SUSTAINABLE SOLUTIONS
RED RIVER CULLIGAN IS COMMITTED TO A WORLD OF BETTER WATER.
Our organization is dedicated to fostering a more sustainable future. In pursuit
of this goal, we are steadfast in our commitment to enhancing our social and
environmental footprint, with the world that is superior to the one we currently
inhabit.
#1 eco-friendly and sustainable provider of premium drinking water
40 billion fewer plastic bottles used globally each year thanks to Culligan
products
13 million homes, offices, and businesses globally using our cleaner, safer,
soft water
With this combination of water resources, Denison & Sherman water quality often
faces our share of water filtration and treatment issues:
Surface water, like rivers and snow melt, absorb contaminants that can be
harmful for consumption as well as annoying around the home. Most of these
contaminants include naturally occurring bio materials and minerals. This means
water quality can worsen seasonally when warming temperatures contribute to
algal blooms, or heighten water sensitivity to microorganism growth.
Ground water presents its own treatment challenges and filtration issues, so
Denison & Sherman residents with primarily ground water service may see
different water problems than those using water from Denison & Sherman’s surface
water sources. Most often, these manifest as hard water problems which cause
buildup on faucets and fixtures, and can be hard on appliances and plumbing.
The Denison & Sherman area gets its drinking water from a number of surface
water resources, mainly which include rivers, lakes, streams, ponds, reservoirs,
springs, and wells. Ground water is not a significant source of public water
supply in the area. Denison & Sherman is located on aquifer but does not use
groundwater for its municipal supply.
The Denison & Sherman has several water treatment challenges. This includes
“Forever chemicals”, or PFAS, which has been found in the water supply at levels
that exceed federal limits. Six different water systems, including Fort Worth,
Grapevine, Haltom City, Arlington, Lake Worth, and Weatherford, have reported
high PFAS levels.
Disinfection byproducts are also common issues in water treatment for the area.
Denison & Sherman uses a mixture of chlorine and ammonia (chloramine) to reduce
the formation of byproducts, but these issues still persist.
Many areas such as Denison & Sherman face challenges with aging water
infrastructure, which can impact water quality and treatment effectiveness.
Addressing these problem presents ongoing problems, which is why home water
treatment solutions are recommended.
Culligan of Denison & Sherman
1732 W Morton St.
Denison, TX 75020
(903) 582-6910
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