128-6105
6 of 6
6
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.
Transmitter model number is found on rear case.___________________
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 ;
01333 01333
01333 01333
01333
60 60
60 60
60
61 61
61 61
61
150 . , .. 11788 150 . , .. 11788
150 . , .. 11788 150 . , .. 11788
150 . , .. 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.
128-6105
