Loading

Multipure's Automatic Filter Reorder Program

By signing up for this program, you will Save 15% on your filter purchase

 
 *(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:

 I other; Please Specify:
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:
 CVV2 (three-digit number on back of credit card; AMEX number will be on front):
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 Multipure does not share its customer information with anyone.

 

Thank you for signing up to receive your filter automatically.

 

I agree to notify Multipure 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.

 

Please enter the characters you see in the image:


Image verification

 

If you cannot read the image, click for a new one