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

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.

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

Original Order Number (if known):  
        (text in red is a required field)

Last Name:                                                                 First Name:
                                     

Address:
 

City:                                            State:                 Zip:
                                 

*Home Phone:            *Cell/Work Phone:
   

*Email:

Filter Type:

Date to Start Auto Shipments:
 

How often to have filters sent (specify 2 to 12 months) thereafter:

Type of Credit Card:

Credit Card Number:        Expiration Date:
            

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

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.

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.