home » customer service » 3 in 1 Propane, Methane and CO Detector Order Form

3 in 1 Propane, Methane and CO Detector Order Form

Proulx Oil & Propane sells the 3 in 1 Propane, Methane and CO Detector for $74.95 shipped directly to you. Please fill out this form to order. Required fields are denoted with a red asterisk (*).

Credit Card Information

---

*First Name on Card:
*Last Name on Card:
Company:
*Billing Street:
*Billing City:
*Billing State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
*Billing Zip Code:
*Credit Card Type:	MasterCard Visa
*Credit Card Number:
*Expiration Date (mm/yy):	/
*CVV:
*Quantity Requested:	at $74.95/each (plus $14.95 shipping per order) RECOMMEND MIN. 1 per FLOOR in your home (e.g. basement, first, second = 3 total)
Shipping Information If you wish to ship the device(s) to a different address than above fill in your shipping address below.
Shipping Street:
Shipping City:
Shipping State:	--- Select --- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Shipping Zip Code:
Contact Information
*Phone Number:
Fax Number:
*Email Address:
Additional Information
Comments:
Would you like to receive email reminders and special promotions from Proulx?
	Yes, please notify me No, thanks
What is seven+six?	Why are you asking me this? (enter your answer as a number, as in six+one=7)