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VIQUA Product Registration Form

Complete our product registration form below for annual email reminders when it's time to change your lamp.

By filling out this form, I confirm that I have reviewed and agree with VIQUA's Privacy Policy. I also understand my privacy choices as they pertain to my personal data as provided in the VIQUA Privacy Policy under “Your Privacy Choices".
Your Product
Lead Source
Dealer country Code
Model*
Serial Number*
Where do I find my model number?

The model number for your VIQUA system, which starts with an alpha character, can be located on the silver label that is adhered to the UV stainless steel chamber. Older model systems may be labelled UVMax or Sterilight.
Where do I find my serial number?

The serial number for your VIQUA system, which is a 9-digit numerical value, can be located on the silver label that is adhered to the UV stainless steel chamber, underneath the model number.
Model Lamp Number
Your Information
Full Name*
first name
last name
Email Address*
Phone Number*
Country*
Purchase Information
Purchase Date*
Date Format: MM slash DD slash YYYY
Installation Date*
Date Format: MM slash DD slash YYYY
- Send me email reminders when it’s time to change my VIQUA lamp.
- I give VIQUA permission to provide me with information about their products and services, and related products and services from VIQUA's affiliates.

VIQUA Product Registration Form

Complete our product registration form below for annual email reminders when it's time to change your lamp.

By filling out this form, I confirm that I have reviewed and agree with VIQUA's Privacy Policy. I also understand my privacy choices as they pertain to my personal data as provided in the VIQUA Privacy Policy under “Your Privacy Choices".

Where Did You Purchase Your Product ?
Purchase From/ Dealer Name
City*
Record Type Hidden Viqua Validated WTL
Dealer Account Id hidden field viqua validated
Dealer Email Id hidden field viqua validated
Dealer Phone hidden field viqua validated
Dealer Address1 hidden field viqa validated
Dealer City hidden field viqua validated
Dealer State hidden field viqa validated
Dealer Country hidden field viqa validated
Dealer Zip hidden field viqa validated
I Dont know organization vendor identifier hidden field
Language
organization_vendor_identifier
- Viqua Validated WTL
- Other, not listed (Please specify)
- Dont know
Record Type Hidden VIQUA Warranty Web Generated Other not listed
Dealer Name*
Country*
Dealer Phone
Dealer Email
Additional Information

Please Tell Us More About Water Issue
Your Water Source
Type Of Building
Reason For Purchase
Reason for purchase Other
How did you find out about this product?
How did you find about this product other?
Do you have any other water conditioning products? (Type all that apply)

VIQUA Product Registration Form