To Maintain Your Lifetime Housing Warranty
Sign up for Multi-Pure's Automatic Filter Reorder Program

By signing up for this program, you will Save 10% on your filter purchase
(save 10% off the retail price of the filter, for current filter prices, click here)

We will automatically ship your filter when you request it and in the future at the time interval you specify. Your credit card account will be charged for the filter, sales tax, and shipping and handling.

If you have any questions, please contact us at 800-622-9206

(Note: to fill this form out on our secure page, click here - the yellow lock box on the bottom right hand side tool bar or on the top address bar will now show up)

 
*(text in red is a required field)

Original Order Number (if known):
Last Name:		First Name:
Address:
City:		State:	Zip:
Former mailing address (if moved in the last 5 years):
*Home Phone:		*Cell/Work Phone:
*Email:
Filter Type: Please select CB6 (for models MP750Sx, MP500Sx, MP1200, MP900 CB6AD (for MPAD) CB5 (for model MPC400, MPC250) CB11As (for models MP880Sx) TO20 (for whole house system) SFFI (for shower unit) Other, please specify: I other; Please Specify:
Date to Start Auto Shipments:
How often to have filters sent (specify 2 to 12 months) thereafter: Please select Every 2 months Every 3 months Every 4 months Every 5 months Every 6 months Every 7 months Every 8 months Every 9 months Every 10 months Every 11 months Every 12 months
(Note: to fill this form out on our secure page, click here - the yellow lock box on the bottom right hand side or on the top address bar will now show up)
Type of Credit Card: Please Select Visa MasterCard American Express Discover	Credit Card Number:	Expiration Date:	CVV2 (three-digit number on back of credit card):
Billing Address of Credit Card if different from Above:
Billing City/State/Zip:
Comments:

* Your phone number and email address are requested so we can contact you in the event we have a question about your auto order or credit card information. Please be assured that Multi-Pure does not share its customer information with anyone.

Thank you for signing up to receive your filter automatically.

I agree to notify Multi-Pure Corporation of any change in address or credit card account information in a timely manner so as to avoid unnecessary costs in processing and shipment.

By clicking the submit button you agree to have a filter shipped to you at the time interval you specified above and that your credit card account will be charged for the filter, sales tax, and shipping and handling.

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