NEW URPRO EASY-ORDER FAX FORM
The Information You Provide is Confidential and Will NOT be Shared or Sold

1. COMPLETE Each Line Below Using Your Computer
2. Click on the Submit Button to go to the next page.
3. PRINT Completed Easy-Order Form
4. FILL in your credit card information.
5. SIGN Credit Card Authorization (Black Ink)
   • Unfortunately, PHONE ORDERS CANNOT BE ACCEPTED
   • To protect your security, our Credit Card Provider requires a signed authorization 
6. FAX to URPRO = + 1-630-961-2622 (Secure/Dedicated)
       URPRO Alternate Fax = + 1-630-778-0459

Date: Your Name: Company: Your Email Address: Your Phone Number: (Include Country Code) Your Fax Number: (Include Country Code) Shipping Address: Shipping Address: City: State/Province: Country: Zip Code/Postal Code:

I Wish to Order the Following URPRO Filter(s)*
Most URPRO Filter Prices are posted on our URPRO web site www.urprofilters.com
 

SIZE	QUANTYITY	CY	GR	SWCY	Glass/Plastic	PRICE
mm/inches	number of filters	tropical blue-green water	green algae water	shallow blue-green water (glass only)	optical glass / optical plastic	US$
					Optical Glass Optical Plastic		US$
					Optical Glass Optical Plastic		US$
					Optical Glass Optical Plastic		US$

* Plus Shipping and Handling
* ALL Shipping rates vary with location and carrier