Printable Order Form

Those uncomfortable with using credit cards on the Internet or for those who simply prefer to conduct business by more traditional means may print this page from your browser.

You can use the regular U.S. Postal Service to send this form with check or money order to:
      CuZn Water Filtration Systems
      15 West South Street
      Fayetteville, AR 72701

You can also FAX us the form and credit card information 24 hours a day at 479-443-4710.

BETTER YET!
Just call us at 1-800-345-PURE (1-800-345-7873)!! We really do like answering your questions and taking your orders in person.

QTY.	ID NO.	PROD. NO.	NAME	PRICE	SHIP.	TOTAL
	78972	BB-104	BATH BALL TUB FILTER	$49.95	$7.00
	78969	TS-103	TURBO SHOWER WITH POWER DISK	$49.95	$7.00
	78973	HF-103	HEAD-FREE POWER SHOWER	$59.95	$7.00
	78964	CT-101D	COUNTER TOP – WHITE WITH DOUBLE DIVERTER, REFILLABLE	$159.00	$8.00
	78963	CT-101S	COUNTER TOP – WHITE WITH SWIVEL SPOUT, REFILLABLE	$159.00	$9.00
	78962	CT-101SC	COUNTER TOP – CHROME WITH SWIVEL SPOUT, REFILLABLE	$189.00	$9.25
	78968	CT-10S	TRAVEL COMPANION COUNTER TOP FILTER	$59.95	$9.00
	87022	CT-50S	NON-REFILLABLE COUNTER TOP FILTER WITH SPOUT	$149.00	$8.00
	87023	CT-50D	NON-REFILLABLE COUNTER TOP FILTER WITH DOUBLE DIVERTER	$149.00	$8.00
	78960	IL-200	IN-LINE WATER FILTER	$69.00	$7.75
	82816	RV-200	RV FILTER SYSTEM	$99.00	$9.25
	78970	SB-24	SPORTS BOTTLE PORTABLE FILTER	$24.95	$7.75
	82822	UC-101	UNDER COUNTER – REFILLABLE	$159.00	$9.00
	78961	UC-200	UNDER COUNTER WATER FILTER	$229.00	$10.00
	82817	WW-101	MAGIC WAND DECHLORINATOR	$24.95	$7.00
	78967	DT-40	DOUBLE TANK WHOLE HOUSE FILTER	$1795.00	$54.00
	82820	WH-200B	SINGLE TANK WHOLE HOUSE SYSTEM	$1395.00	$28.00
	78976	ES-101	WATER SAVER SHOWER HEAD	$7.95	$5.00
	78975	ES-102	MASSAGE SHOWER HEAD	$14.95	$7.00
	82818	FR-1	FLUORIDE REMOVAL CARTRIDGE	$69.95	7.75
	78965	KR-101A	REFILL CARTRIDGE – ABSOLUTE 1 MICRON FILTERING	$69.95	$9.00
	78966	KR-101N	REFILL CARTRIDGE FOR COUNTER TOP UNITS (5 MICRON)	$49.95	$7.75
	78974	SR-103	POWER DISK REFILL FOR SHOWER FILTERS	$24.95	$5.00
	78971	SR-24	REFILL FOR SPORTS BOTTLE	$19.95	$7.00
SUBTOTAL
Arkansas Residents 6% Tax
TOTAL ENCLOSED

Name:	_______________________________________________________
Shipping Address:	_______________________________________________________
City, State Zip:	_______________________________________________________
Country:	_______________________________________________________

For credit card orders, the following must also be filled out completely:

Name of cardholder:	_______________________________________________________
Mailing Address:	_______________________________________________________
City, State Zip:	_______________________________________________________
Country:	_______________________________________________________
Day and Night Phone:	_______________________________________________________
Circle One:	VISA Mastercard Discover
Credit Card Number:	_______________________________________________________
Date of Expiration:	_______________________________________________________

PRINTABLE ORDER FORM

BETTER YET!Just call us at 1-800-345-PURE (1-800-345-7873)!! We really do like answering your questions and taking your orders in person.

QTY.

ID NO.

PROD. NO.

NAME

PRICE

SHIP.

TOTAL

BETTER YET!
Just call us at 1-800-345-PURE (1-800-345-7873)!! We really do like answering your questions and taking your orders in person.