VISA Gift Card!
2014 Referral Promotion!
Complete your information and names of referrals...then click SUBMIT!

$100 Visa Gift Card...on Rainsoft!

Help us with our word of mouth referral program.  Give us the names of friends and relatives that deserve the same clean water that you are enjoying.  If they decide to make this investment and have a RainSoft system installed, YOU will receive a $100 prepaid Visa gift card. 

It's really simple!
Either complete the fields below and submit online, OR print out the form (at right) and mail or fax back to us.

Your Name


Your Address


City, State, Zip Code


Your Phone Number (include area code)


Your Originating Office (e.g. Lafayette)


Amount of Your Original Sale


Type of Equipment


Original Sales Rep


Date of Original Sale



REFERRALS

1. Referral

Name | City | Phone # | Alt. Phone # | Relationship

2. Referral

Name | City | Phone # | Alt. Phone # | Relationship

3. Referral

Name | City | Phone # | Alt. Phone # | Relationship

4. Referral

Name | City | Phone # | Alt. Phone # | Relationship

5. Referral

Name | City | Phone # | Alt. Phone # | Relationship

6. Referral

Name | City | Phone # | Alt. Phone # | Relationship

7. Referral

Name | City | Phone # | Alt. Phone # | Relationship

8. Referral

Name | City | Phone # | Alt. Phone # | Relationship

9. Referral

Name | City | Phone # | Alt. Phone # | Relationship

10. Referral

Name | City | Phone # | Alt. Phone # | Relationship

11. Verifier

For security purposes, we ask that you enter the security code that is shown in the graphic. Please enter the code exactly as it is shown in the graphic.
Your Code
Enter Code

Copyright © Jodon Enterprises LLC, dba Superior Water, Scott, Louisiana
superior@superiorwaterla.com