Pool Alarm Order Form

Important: When you have filled out the form to your satisfaction, click on the SEND button at the very bottom of the form to enter your order. If you have the Netscape browser, version 1.22 or later and the key at the bottom is broken, you can encrypt your order for the latest in privacy and credit card security.

Order Information: *Distributors Only*

PA 100, Pool S.O.S., $49.95
PA 200, Pool S.O.S. plus Remote, $149.95

Prices include shipping UPS 3 days.

- Alarm Model (PA 100, PA 200)

- Cost

- Quantity

- Total Cost

Bill to:

- Name

- Street Address

- City

- State/Province

- ZIP/Postal Code

- Country

- Daytime Phone

- E-Mail Address

Credit Card Account:
VISA Mastercard

- Credit Card #

- Name on card

- Expiration Date

Send To (if different than Bill To):

- Name

- Street Address

- City

- State/Province

- ZIP/Postal Code

- Country

- Daytime Phone

I am very interested,
Please send me more information
Please contact me to discuss further (fill in the above contact information)

Terms

Prices include shipping and handling. All orders sent UPS 3 Days.

- (select to send order) - (select to clear the form)