Hot Water Recirculating System-Residence Questionnaire

Koenick Electronics
Water Guardian
Hot Water Recirculation Systems
Mail-In Order Form
Remote Control for Clock System

Print this page. Complete the form and mail with your check or money order
TO: KOENICK ELECTRONICS INT'L - 301 N. Whitetail ~ Payson, Arizona 85541

WE GUARANTEE ALL INFORMATION YOU GIVE BELOW WILL BE HELD COMPLETELY CONFIDENTIAL!

ea.	Remote Control - MCU 7 R *Remote Control For Option A. B or C*	$ 219.00	$
ea.	Remote Control Transmitter T-90 *Extra Transmitter For Remote Control Units*	$ 26.00	$
ea.	Time Clock Control MCU 4	$ 24.00	$
Ariz. Sales Tax, if applicable 8.72%			$
Freight Cost from: Zip 85541 to Zip: ________			$
TOTAL COST			$

Name:

Address:

City:

State:

ZIP:

Telephone including area code:

FAX:

Alternate Telephone:

Best time to call: a.m. p.m.

E-mail Address:

NOTE: Material Shipped within 5 Working Days after receipt of payment.
"Please": NO CREDIT CARDS, they only increase the cost of goods.

Koenick Electronics Int'l
301 N. Whitetail
Payson, Arizona 85541

If you would like for us to get a head start on your order, click here to e-mail this info. to the factory. Then send your payment by mail with a printed copy of this form.

If you have any questions or need assistance please call the factory.
Phone: (928) 472-9200 or (480) 664-2237 ~ Fax: 1 (928) 472-9202
For any further questions a representative from the factory will call you
from Payson, Arizona.