Please complete this form so you can become part of the solution as one of PHSI’s Partners for Success! Pure Health Solutions Inc. ∙ 120 E. Lake St., Suite 401, Sandpoint, ID 83864 ∙ Phone: 800-265-5167   Salutation: --None-- Mr. Ms. Mrs. Dr. Prof. First Name: Last Name: Title: Company: Email: Phone: Extension: Address: City: State/Province : Zip : Country: Industry Background: --None-- Office Products Water Purification OCS Vending Other Years in Business: --None-- 1-3 4-6 7-10 11-15 16-20 20+ Description of Facilities: Sales Area Requested: Comments: Privacy Policy: We will not share your information with third parties PERIOD.