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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. Please indicate which button pad is used with your
transmitter as indicated above.
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
* Make checks payable to Audiovox Corporation
7. Credit Card Number : ___________________________________________
8. Credit Card Expiration Date : __________________________
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.
9. Mail this form, and your check, to ;
.: .: .: .: .:
99
99
3
3
99
99
99
3
3
3
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Check or money order * (do not send cash)
150
150
150
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150
150
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11788
11788
11788
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11788
11788
128-5749A
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