* denotes
mandatory fields
Product Name:*
Please Select One
dragon-fly M18
Gurgle F38 Faucet Filter
Pitcher P18
K18 Track Membrane
eLife eW-7 Water Filter
eLife eS-7 Shower Filter
eLife Vending Machine
Type of Purchase/ Interest:*
Please Select One
Personal
Corporate
Product Serial No:
This no. can be found • at the back
of your dragon-fly Aquovator • at the bottom
of your Gurgle packaging box
Your Name:*
Home Address:
City:
Country: *
Please Select a Country
Argentina
Australia
Austria
Bangladesh
Belgium
Bolivia
Brazil
Bulgaria
Canada
Chile
China
Colombia
Costa Rica
Croatia
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Estonia
Europe
Finland
France
Germany
Greece
Guatemala
Hong Kong SAR
Hungary
India
Indonesia
Ireland
Israel
Italy
Japan
Kenya
Korea
Latvia
Lithuania
Latin America
Luxembourg
Macedonia
Malaysia
Mexico
Middle East HQ
Morocco
Netherlands
New Zealand
Norway
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Romania
Russia
Saudi Arabia
Serbia and Montenegro
Singapore
Slovakia
Slovenia
South Africa
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Thailand
Turkey
United Kingdom
United States
Uruguay
Venezuela
Vietnam
Zip/Postal Code:
Company Name:
Company Address:
Contact No. (Home/ Mobile) :*
Contact No.(Office) :
Fax :
Email Address: *
Date of Purchase (DD/MM/YY):
How many people live in your household?
Where did you purchase your Hyflux product?
Please Select One
Departmental Store
Supermarket/ Hypermart
Hardware/Home Improvement Shop
Discount/Mass Merchandiser
Speciality Store
Direct Sales
Roadshow
Others
How did you first hear about the Hyflux
products?
Please Select One
Magazine/TV Advertisement
Recommandation from family/friend
In-store shelf and signage
Recieved as a gift
Online website
Retail sales person
What factors influenced your
decision to purchase Hyflux product? (Check
all that apply)
Before I started using Hyflux, my primary
source of drinking water was:
Please Select One
Tap water
Bottled water
Filtered water
Others
Please indicate how satisfied you are with
your Hyflux product based on each of the following
- 5 being "very satisfied" and 1 being
"very dissatisfied":
Design
1
2
3
4
5
Installing your new filter
(clear instructions, ease of installing)
1
2
3
4
5
Flushing process of your new filter before
use
1
2
3
4
5
Water flow speed
1
2
3
4
5
Filtering capabilities of your new Hyflux
product
1
2
3
4
5
Taste
1
2
3
4
5
If you're replacing a
water filtration system:
What brand are you replacing?
What type of water filtration system are you
replacing?
Please Select
One
Pitcher Filter Tap
Mount System
CounterTop System
Under-sink system
Whole-house system
Others
Other Comments:
Press “Submit” when you've completed or
“Clear” to start over again.