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)

*(text in red is a required field)

Original Order Number (if known):
Last Name:		First Name:
Address:
City:		State:	Zip:
*Home Phone:		*Cell/Work Phone:
*Email:
Filter Type: I other; Please Specify:
Date to Start Auto Shipments:
How often to have filters sent (specify 2 to 12 months) thereafter:
(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)
Type of Credit Card:	Credit Card Number:	Expiration Date:
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.

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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

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