Qualify for your FREE Air Purifier! ($150 Value)

GREEN FROG SYSTEMS, Central Pennsylvania Distributor

- Please complete survey to see if you qualify for a "RainMate" Fresh Air Machine.
- Must have a Facebook account to qualify.
- Subject to company rules.

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* 1. Name of friend that sent you to us?
(Please put first and last name so they get credit.)

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* 2. Since living in the area, do you believe the air quality in your area has gotten..

Better

Worse

Stayed the same

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* 3. Does anyone in your home suffer from:

Allergies

Asthma

Breathing Issues

None

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* 4. Do you have:

Children

Pets

Dust

Odors

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* 5. What is your marital status?

Single

Co-habitating with Significant Other

Married

Widowed

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* 6. What is your age category?

18 - 25

26 - 35

36 - 45

46 - 59

60 - 70

71+

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* 7. Do you own or rent your home?

Own

Rent

Stay with friends or family

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* 8. What do you do for work?

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* 9. What does your spouse do for work?

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* 10. Household Income:

Under $25K

$25K - 50K

$50K - 100K

$100K Plus

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* 11. Are you interested in earning extra income?:

Yes

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* 12. Contact Information (We will contact you by phone or text message)

First Name

Last Name

Spouse/Significant Other's Name

Street Address

City/Town

State/Province

ZIP/Postal Code

Phone Number

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* 13. Best time to reach you?

Morning

Afternoon

Evening

Anytime

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* 14. If you are selected for the Rainmate from our company, we will reach out to you at the phone number you provided to set an appointment to deliver your free Rainmate Fresh Air Machine.

Great, I'm all for that!

Question Title

* 1. Name of friend that sent you to us?(Please put first and last name so they get credit.)

Question Title

* 2. Since living in the area, do you believe the air quality in your area has gotten..

Question Title

* 3. Does anyone in your home suffer from:

Question Title

* 4. Do you have:

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* 5. What is your marital status?

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* 6. What is your age category?

Question Title

* 7. Do you own or rent your home?

Question Title

* 8. What do you do for work?

Question Title

* 9. What does your spouse do for work?

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* 10. Household Income:

Question Title

* 11. Are you interested in earning extra income?:

Question Title

* 12. Contact Information (We will contact you by phone or text message)

Question Title

* 13. Best time to reach you?

Question Title

* 14. If you are selected for the Rainmate from our company, we will reach out to you at the phone number you provided to set an appointment to deliver your free Rainmate Fresh Air Machine.

* 1. Name of friend that sent you to us?
(Please put first and last name so they get credit.)