Name *
If you're representing an organization interested in having multiple Drinkwell Entrepreneurs across your coverage area please include your organization's name here.
Phone *
Include type of business, number of employees, revenues, and how long you've been in operation. Non-profit/NGOs are applicable, please make a note saying so. If you haven't run any business or NGO before, write "N/A"
What are the most common contaminants in drinking water in your area? *
Enter 0 if no one pays for water in your community.
If possible, highlight any partnerships you'd create with NGOs, schools, local government officials, and/or religious officials due to existing working relationships.