Skip Navigation LinksHome » Become a Customer » Residential Customer Sign Up

Residential Customer Sign Up

Please provide your contact information below and a Premium Refreshment Service Account Executive will contact you within 24 hours. You may also call us at (800) 467-1133 to speak directly to a representative. We offer Refreshment options including Bottled Water, Coffee and Refreshments, and Water Filtration.

The convenience of door to door delivery is just a click away.

Complete the following information to begin enjoying Premium Refreshment at home.

Contact Information

(* Required)

* Full Name:
* Phone Number:
* Address:
* City:
* State:
* ZIP Code:
* Email Address:
* Confirm Email Address:
* Preferred Method of Contact?
* Best time to contact?


Additional Information

Additional Comments and Information: