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PureAirPlus.com
PLEASE PRINT THIS FORM
OUT - YOU CANNOT USE IT ONLINE |
| Your Name: | ____________________________ |
| Phone Number: | ____________________________ |
| Email Address: | ____________________________ |
| Ship to: | |
| Name: | ____________________________________ |
| Address: | ____________________________________ |
| City, State Zip | ____________________________________ |
| Country | ____________________________________ |
| DESCRIPTION |
QTY |
Unit
Price |
Total |
| BME size # 1 Air Unit & Kit | $895.00 CAN | ||
| BME size # 2 Air Unit & Kit | $995.00 CAN | ||
| BME size # 3 Air Unit & Kit | $1095.00 CAN | ||
| BME size # 4 Air Unit & Kit | $1195.00 CAN | ||
| BME size # 1 UV Purification Unit & Kit | $1495.00 CAN | ||
| BME size # 2 UV Purification Unit & Kit | $1595.00 CAN | ||
| BME size # 3 UV Purification Unit & Kit | $1695.00 CAN | ||
| Accesories | |||
| Snorkel to raise exterior air access | $130.00 CAN | ||
| Replacement UV lamp | $229.00 CAN | ||
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Total Price: |
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( ) I am enclosing a check or money order Please note that we do not accept checks by fax, so if you are paying by check you must mail it in. Make money orders payable to Pure Air Plus
Note: All overseas
orders will be charged an according to distance or country for shipping. We normally
ship by UPS Parcel Service (the package is quite expensive to ship
overseas). Delivery time is approximately 2-3 weeks in the US and Canada. Longer for overseas orders.
VISA
Expiry Date: _________ Signature: _________________________ I authorize
Pure Air Plus to charge my credit
card. |