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IMPORTANT: To help us expedite your order, please print all of the
information legibly, and mail this form and your payment according to the
instructions below.
1. Name : ______________________________________________________
Address : _____________________________________________________
City : ___________________ State : ________ Zip Code : ______________
2. Telephone Number : ( ________ ) ________________________________
3. Enter the total number of transmitters required here : ____________________
4. The cost per transmitter is $ 65.00.
5. Enter the total amount enclosed here : _______________________________
( New York state residents must include the appropriate sales tax. )
6. Method of payment; check one of the boxes below.
Mastercard Visa Check or money order * (do not send cash)
* Make checks payable to Audiovox Corporation
7. Credit Card Number : ___________________________________________
8. Credit Card Expiration Date : __________________________
9. Mail this form and your check, to :
2 2
2 2
2
. 95 2 . 95 2
. 95 2 . 95 2
. 95 2
150 .150 .
150 .150 .
150 .
, .. 11788, .. 11788
, .. 11788, .. 11788
, .. 11788
: :
: :
:
Credit card purchasers can order additional or replacement
transmitters by phone. Simply dial 1 - 800 - 645 - 4994, and
follow the instructions from the operator interface.
128-4624C
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