PoolPak® Filter Auto-Ship Program
Form No: RPW02-FILTRSHIP-20161019
Supersedes: RPW02-FILTRSHIP-20140314
One of the best ways to insure your equipment is operating properly is to perform regularly scheduled
maintenance. Monthly and annual maintenance programs are required to prevent system failure and
costly downtime. One of these monthly procedures is to inspect the air filters for dirt and debris which
can cause damage to your unit.
At no additional charge to you, we offer a program to have your replaceable air filters delivered to
your facility when you need them.
This program is currently available for all PoolPak® products including the PoolPak® MPK Series,
PoolPak® SWHP Series, ComPak™ Vertical, ComPak™ Horizontal, and the RoofPak Series. For
more information on PoolPak® air filters, consult the latest PoolPak® Air Filter document form
number: SVW02-FILTR.
To participate in this program, fill out the necessary information on the form below and return it to us.
You will receive confirmation from our Replacement Parts Team within 24 hours. PoolPak® reserves
the right to make price adjustments without notification. Any price increase will occur during the end of
the fiscal year between December and January.
PoolPak® recommends using factory authorized replacement parts for all units. Contact the
Replacement Parts Team at (800) 959-7725 for pricing and availability.
PoolPak® Filter Auto-Ship Program Application Form
Facility Name & State
PoolPak®
Model No.
_________________________________
___________
_________________
_________________________________
___________
_________________
_________________________________
___________
_________________
_________________________________
___________
_________________
_________________________________
___________
_________________
Filter Shipment Frequency
Monthly
Every 2 Months
Every 3 Months
PoolPak®
Serial No.
Every 4 Months
Shipment Begin Date
____/___/____
P.O. No. _____________________
Billing Address
Shipping Address
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
Contact
__________________________
Contact
__________________________
Phone
__________________
Phone
__________________
Fax
__________________
Fax
__________________
I authorize PoolPak International LLC to ship one (1) set of replacement air filters, per quantity and frequency
designated, for each PoolPak Unit listed above.
___________________________________________
________________
Authorized Signature
Date
___________________________________________
Printed Name
Tax Exempt?
No
Yes (Please provide a copy of tax exempt certificate with this form.)
Return all completed information via email, fax or letter to:
PoolPak International LLC
Attn: Parts Replacement Team
3491 Industrial Drive
York, PA 17402 USA
(800) 959-7725 Voice
(717) 718-1718 Fax
[email protected]
Parts Department Only
Part No.:
1 ______________
2 ______________
3 ______________
Size:
#/Set
________ _____
________ _____
________ _____
Price / Set
$__________/Set
$__________/Set
$__________/Set
Total:
_____________