A/C Filters & Furnace Filters
FAX IN - Order Form
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Please print this form and attach additional sheets if needed.
You may fax this completed page 24/7 to: 1-386-490-4033.
Orders are processed 24 hours a day for fast delivery, you will 
receive an email order confirmation within 24 hours.

   PLEASE PRINT THIS PAGE AND FILL OUT:
   HIGHEST PRICE FILTER FIRST, ADDITIONAL FILTERS RECEIVE 20% OFF

   (1). ELECTROSTATIC FILTER

   LENGTH______________  WIDTH________________ THICKNESS (Circle)   1"   2"  

   PRICE SHOWN ON SITE $____________

   ADDITIONAL FILTERS RECEIVE 20% OFF DISCOUNT

   (2). ELECTROSTATIC FILTER

   LENGTH______________  WIDTH________________ THICKNESS (Circle)   1"   2"  

   PRICE SHOWN ON SITE $____________

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   (3). ELECTROSTATIC FILTER

   LENGTH______________  WIDTH________________ THICKNESS (Circle)   1"   2"  

   PRICE SHOWN ON SITE $____________

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   (4). ELECTROSTATIC FILTER

   LENGTH______________  WIDTH________________ THICKNESS (Circle)   1"   2"  

   PRICE SHOWN ON SITE $____________

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 Merchandise TOTAL:$________________


  UNITED PART SUPPLY

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  SHIPPING:
  Free ground shipping for all filters over $150 to the 48 states.
  Shipping times are for after the filter is made. (USUALLY WITHIN 24 HRS).

    Please underline or circle your shipping option.

    Free UPS Ground Shipping, 48 States - My Order Is Over $150.
   $13 - UPS Ground 48 States
   $60 - Hawaii-Alaska (Air)...2-7 Days
   $44 - Canada Delivery UPS, 1-7 Days
   $41 - US Military Bases Outside The 50 States, Guam Etc
   $65.00 - Overseas Delivery Postal, 3 - 10 Days

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  BILLING INFORMATION:
 

  Your email address for an invoice we will send to you by email.

 ______________________________@___________________________

 Name. ___________________________________________

 Street Address.______________________________________________


 City.____________________________   State.___________________

 Info for non USA or APO. __________________________________________ 

 Zip______________________     
 

  Home Phone______ ______ _______ Work Phone______ ______ _______


  SPECIAL INSTRUCTIONS OR DIFFERENT SHIPPING ADDRESS.

  ________________________________________________________


 ________________________________________________________

 

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  PAYMENT: CREDIT CARD OR CHECK (CHECK RECEIVES A 10% DISCOUNT).

 Name (on card).___________________________________

Card Type. Card Number.  ___________________________________________

 Expiration Date.   _______ / ________

Card Holders Signature X_____________________________________

 PAY BY CHECK AND RECEIVE A 10% DISCOUNT
10% will be deducted when we receive your order. (USA BANKS ONLY FOR CHECKS)
Returned checks are subject to a $29 fee.

Customer information as it appears on your check:

Payer: __________________________________
Address: __________________________________
City, State & Zip: __________________________________
Phone: __________________________________

Customer Bank Information:

Bank Name: ___________________________________
State The Bank Is Located In: ___________________________________

Bank routing & account information - the line at the bottom of the check

EXAMPLE:

Routing Number:

___________________________

Checking Account Number:

 _____________________________

Check Number:

 ________________________

    For your records take a check from your checkbook and fill it out just as you normally would.
  By ordering and filling out this form you agree to all terms and conditions.

 For questions call : 1-646-688-2772
 
   SIGNATURE   X______________________________________

 

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 FOR OUR RECORDS. Please let us know why you have chosen to use our fax in form
 instead of ordering on our secure online order form. Have you had any problems with
 our online order form?

 ______________________________________________________________________________

          PLEASE FAX 24/7 to 1-386-490-4033.

    FILTER PRICING
    Order any size up to ( 27 X 22 x 1 ) - $135.99, each additional filter 20% off!
    Order and size up to ( 28 X 25 x 1 ) - $163.99, each additional filter 20% off!
    Order any size up to ( 32 X 32 x 1 ) - $195.99, each additional filter 20% off!
    Filters requiring 2" Thickness up to ( 27 X 27 )- $224.99, each additional filter 20% off!