MultiPure Sweepstakes

CASH PRIZES of $100 AWARDED TO 3 WINNERS EVERY QUARTER



I understand that by completing this registration form, I am eligible for the $100.00
Multipure drawing. If my name is drawn, I will receive a check for $100.00.
Submitting distributor will receive $50. If my name is drawn as one of the $100 winners,
I will automatically be entered in Multipure’s $500 Sweepstakes.

Contestant must be 18 years or older to participate.
Name:
Address:
City, State, Zip
Phone:
Email:

How many glasses of water do you drink each day?

Would you like to learn more about how water affects your health?

Do you have a water filter?
           Brand?

Do you drink bottled water?

Are you on a private well?

I am planning to purchase a Drinking Water Sytem in the next:

Would you like to try a MultiPure Drinking Water System in your home for one week FREE:

Best time to call:

My home is:


Submitting Distributor: Keri Raphael #140104
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