Personal Information: 

Pool heat pump desired: If a pool heater that you are interested in is not listed here, or you have an international order. please call (954)532-0430 and we will be happy to give you a special quote.

Model that I would like to order:

You can use this space for comments or special instructions. We give discounts on multiple heaters too.

Method of payment: Choose the type of credit card that you will like to use for your purchase

If you wish to pay by check, please click on this link and fax it back to us together with this order form.

Cardholder's Name:
Credit Card's Billing Address (if different from home address):
City and State:
Zip Code:
Credit Card Number
Expiration Date:	(mm/yy)
For your protection please add the three digits of your Security Code that appear on the back of your credit card as illustrated on the picture below:

Order Confirmation: Please fill out and sign.

I,    authorize Pool Heat Pumps .Com to charge my credit card in the amount of for (heater model #)

Credit card holder please sign printed form: _______________________________________

Date:__________________

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THANK YOU FOR YOUR ORDER