Our Filters At Your Door Application
“Why go to the store”
11512 Robertson Drive Manassas, VA 20109 1-888-559-2207
Your Filter at Your Door membership guarantees that your filter(s) will be delivered on the date that you specified with an e-mail alert both before and after to verify that you did receive your filter(s) and that they were replaced.
Regular filter replacement for your heating and air conditioning equipment can save you hundreds of dollars in yearly energy costs, combined with yearly maintenance by a qualified contractor can save you even more.
NAME: ________________________________________________ DATE___________
PHONE # (home) __________________ (work) _______________ (cell) _______________
E-MAIL (home) ______________________________ (work) _______________________
- Budget Plan: Only $9.95
- This is our most popular filter with an efficiency up to 90%
- For $12.95 you can increase your efficiency to a Merv11 rated filter any filter after that $8.95
- For multiple filters the first filter will be $9.95 then $6.95 or $12.95 and any filter after that $8.95 each.
- Commercial contracts slightly higher, with or without installation
Filter Size (1) ______________Filter Size (2) ______________ Filter Size (3) _______________
Filter Size (4) ______________Filter Size (5) ______________ Filter Size (6) _______________
Start Delivery date: _________________________________________________________________
Please note 1” filters delivered monthly, 4” filters delivered every 4th month unless noted and will be billed according to scheduled delivery. If you wish to customize your delivery please call Filters at Your Door and we can make all necessary changes (703) 330-5573.
Filter Media customers, depending on your cycle you must purchase your first filter at $39.80, then you will automatically start on the budget plan of $9.95 per month with delivery every 4 months.
TERMS: Monthly Investment $______________________________________________
Your filter(s) will arrive 1st thru 10th of the month depending on weekend, holiday or inclement weather.
Billing date subject to change due to holiday or weekend and/or discretion of management
Method of payment (Please complete and sign)
_____Visa _____MasterCard_______Discover_____American Express_______Bill______
Account __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiration Date Mo____ Yr____
Automatic Checking Account Transfer: ___
I hereby authorize the company (see below) to draft the monthly investment of $_________from my checking accounts
I have enclosed a void check as required to initiate the draft program with my bank.