MaIl OrdEr FOrM
Replacement Mineral Absorption Pads
(Warm Mist Humidifiers Only)
Replacement UV (Ultraviolet) Germicidal Bulb
Replacement mineral absorption pads help extend the life of your Germ-
Free Humidifier. Mineral absorption pads and replacement UV bulbs are
available from your retailer or direct from Vicks with the order form below.
We welcome MasterCard, VISA and Discover, or enclose your check or money
order payable to Vicks. Mail your order to the following address:
Phone: 1-800-477-0457
Fax:
508-481-0509
Please allow 10 days for shipping
OrdEr InFOrMatIOn:
Quantity
Item
(P/N: SMFP-3)
Mineral Absorption Pad
(P/N: SF-UV)
Replacement UV Bulb
Shipping and handling
Sales tax:
ShIp tO:
Name:
Street Address:
City/State/Zip:
(City/Providence/postal code in Canada)
Form Of payment:
Card Number
Print name
(as it appears on card)
Cardholders Signature
Kaz Inc.
Consumer Relations
250 Turnpike Road
Southborough, MA 01772
CA 8.3%, FL 7%, MA 5%, NY 8.6%,
TN Residents add 9.8%
Check
Discover
Unit Price
$6.00
$12.00
$6.95
total order price
MasterCard
Total Price
VISA
Expiration Date