PREVENTATIVE MAINTENANCE CHECK APPOINTMENT REQUEST FORMPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Please select the Hicksgas Water Solutions location nearest you: *Arthur, ILBelvidere, ILBloomington, ILBraidwood, ILCanton, ILDecatur, ILDekalb, ILDemotte, INFairbury, ILKankakee, ILKnox, INLafayette, INLake Villa, ILLincoln, ILMarseilles, ILMorton, ILOakwood, ILPontiac, ILRensselaer, INRoberts, ILSpringfield, ILToluca, ILUrbana, ILVandalia, ILWatseka, ILWoodstock, ILName *FirstLastAddress Where Softener is Located: *Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Daytime Phone *How Did You Hear About Us? *I'm a Current Water CustomerIf you would like to order salt or other supplies to be brought to your appointment, please list below:Offer CodeSubmit