RCA CC174

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or MasterCard by
filling in below
USE YOUR CREDIT CARD
IMPORTANT: Copy complete account number
from your VISA card
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IMPORTANT: Copy complete account number
from your MasteKard
Copy Number
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name on
MasterCard
AUTHORIZED SIGNATURE
Prices are subject to change without notice.
Print or type your name and
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‘s A complete and correct order will
address clearly. This will be your ,> save you days of waiting.
mailing label.
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1 Name:
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1 Street:
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Apt:
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, City:
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i State:
Zip:
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Please make sure that both sides of this form have
been filled out completely.
l Allow 8 weeks for delivery.
l All accessories are subject to availability.
l Where applicable, we will ship a superseding model.
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