GOULDS WATER TECHNOLOGY DIVISION
Xylem Employee Internet Access Sign-Up Form
(Use this Sign-Up only if you are an Xylem Employee)
*Red fields indicate mandatory fields
Salesman #:
-
(If a Salesman)
Name: *
Title:
Company Name: *
Address: *
City: *
State: *
----- Please Select a State -----
AK - Alaska
AL - Alabama
AR - Arkansas
AZ - Arizona
CA - California
CO - Colorado
CT - Connecticut
DC - District of Columbia
DE - Delaware
FL - Florida
GA - Georgia
HI - Hawaii
IA - Iowa
ID - Idaho
IL - Illinois
IN - Indiana
KS - Kansas
KY - Kentucky
LA - Louisiana
MA - Massachusetts
MD - Maryland
ME - Maine
MI - Michigan
MN - Minnesota
MO - Missouri
MS - Mississippi
MT - Montana
NC - North Carolina
ND - North Dakota
NE - Nebraska
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NV - Nevada
NY - New York
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VA - Virgina
VT - Vermont
WA - Washington
WI - Wisconsin
WV - West Virginia
WY - Wyoming
DC - District of Columbia
PR - Puerto Rico
----- Or a Canadian Province -----
AB - Alberta
BC - British Columbia
NB - New Brunswick
MB - Manitoba
NL - Newfoundland and Labrador
NT - Northwest Territories
NS - Nova Scotia
NU - Nunavut
ON - Ontario
PE - Prince Edward Island
QC - Quebec
SK - Saskatchewan
YT - Yukon Territories
-------- Other --------
Postal or Zip Code: *
Country or Region: *
----- Please Select a Country or Region -----
United States
Canada
North America
South America
Europe
Asia
Africa
Other
Email Address: *
Telephone No: *
Additional Address Information:
Message to Goulds:
Check the applications you would like access to:
Order Status
Warranty Claims (Inquiry Only)
Product Availability
Warranty Claims (On-Line Processing)
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