Untitled Document

	Select your showerhead
	Roadrunner ($15.00 + S&H) Gecko (FREE + S&H)

	BILLING INFORMATION

	Name	required.
	Billing Address	required.
	City	Required.
	State	ChooseRequired.
	Zip Code	RequiredInvalid format.
	Phone	Required
	email	RrequiredInvalid format.


	SHIP TO ADDRESS (if different than billing address)

	Street
	City
	State
	Zip Code

	ADDITIONAL INFORMATION

	KEC account number	RequiredInvalid format.

	What type of water heater do you have?

	Water Heater Type	Required
	CREDIT CARD INFORMATION

	Card Number	Required
	3 or 4 digit Code (whats this)	RequiredRequired
	Card type	select card type
	Expiration Month	RequiredRequired
	Expiration Year	Required

	By submitting this form, you agree to the terms of receiving a free or discounted showerhead from Kootenai Electric Coop – I have an electric water heater and as such, by receiving said shower head, I authorize KEC or our authorized agent to verify the installation as to meeting our terms. *NOTE*You will receive an email confirmation of your purchase with S&H charges of approximately $6.50 to be included.