ABOUT          Your name:
YOU       e-mail address:
               telephone:
                     fax:
SHIP-TO
ADDRESS:            name:
                   line2:
          Street Address:
                   line4:
City and state or region:
 Country and postal code:

IF YOU ARE PAYING BY CREDIT CARD AND YOUR SHIP-TO ADDRESS IS DIFFERENT
FROM THE CREDIT CARD BILLING ADDRESS, PLEASE INCLUDE THAT CREDIT
CARD BILLING ADDRESS AS WELL. PLEASE WRITE IT ABOVE, TO THE RIGHT
OF THE SHIP-TO ADDRESS. THANK-YOU.

Form of payment (circle): 1. Visa             2. Mastercard     3. Discover 
                          4. American Express 5. Purchase Order 6. Check 
Credit Card Account number:
                            - - - -   - - - -  - - - -  - - - -
Your full name -- as it appears on the card, 

Exipration Date: month         year

Circle the items you are ordering and indicate the quantity ordered.

qty   item             price/unit qty    item               price/unit
[   ] seagull countertop 599.95   [    ] Ametek countertop     129.95
[   ] seagull x1f        599.95   [    ] Ametek faucet mod     149.95
[   ] x-2kf              849.95   [    ] Ametek cartridge       39.95
[   ] x-2kb              649.95   [    ] Purest One countertop 300.00   
[   ] seagull cartridge   84.95   [    ] Purest One under-ctr  300.00   
[   ] rs-2sg cartridge $ 169.95   [    ] Purest One cartridge   60.00   
Portables:
[   ] Hand Pump Seagull 519.95    [    ] Trav-L-Pure        149.95
[   ] Hand Pump w/bag   539.95    [    ] Trav-L-Pure cart    49.95
[   ] Portable Conversion kit $129.95
[   ] seagull cartridge  84.95    [    ] Microlite           49.95
[   ] First Need Deluxe  94.95    [    ] Microlite cart(2)   46.95
[   ] First Need cart    49.95    

Whole House:
[   ] x-6 (6 gal/minute) 1449.95  [    ] Spark-L-Pure (26gal/min) 1249.95
[   ] x6 cart (6000 gal)  409.95  [    ] S-L-P cart (30,000 gal)   279.95


Shipment method: ground, 3-day, 2-day, next-day, international
(circle)

Please sign the following statement:
I authorize payment for the items listed above, as well as shipping and
handling costs. If payment is by credit card, I authorize the charge.

your name and date: XX  _____________________________________________


FAX +01 651 704 0002    tel +01 651 704 0077      TOLL-FREE 800 956 7444
Technical Intelligence; 412 Wedgewood Drive; Saint Paul,MN 55115 USA
                     http://www.Drink-Water.com

Order form: 2008.04.01. Seagull, Base Camp, Travl-L-Pure, Microlite, and Spark-L-Pure are trademarks of General Ecology.