We love working with Agents! Fill out the form below with your clients info that’s interested, and earn a 1 month referral for the package they sign up for on us once they sign up! Agent Name * First Name Last Name Agent Email * RE License # * Brokerage Name * Broker Name * First Name Last Name Broker Email * Broker License Number * Client Name First Name Last Name Client Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Client Email * Client Phone * (###) ### #### Make and model of water softener * Checkbox * Disclosure: By submitting this form, you confirm that you have obtained consent from your client to share their information with SimplySaltCT for service-related purposes. All information provided will be used solely for scheduling, monitoring, and delivering water softener salt services in accordance with our privacy policy. Yes, I have their permission Thank you! We will reach out once your client is set up! Please make sure we have a W9 on file from your broker.
