Midland Radio GXT5000 Accessories Order Form, Name Address City State Zip Code Tel email, Mail To

Model GXT5000 Series

ACCESSORIES ORDER FORM

Please send Money Order or fill in Visa/MasterCard information and mail to the address below. Please DO NOT send cash or checks. Make Money Order to Midland Radio Corporation.

Name: ___________________________________________________________

Address: _________________________________________________________

City: _____________________ State __________ Zip Code _____________

Tel: ______________________ email: _________________________________

CC# _____________________ Type: __________ Exp. _________________

Qty	Item	Price	Total
	AVP-1	$19.99
	AVP-H1	$49.99
	AVP-H2	$49.99
	AVP-H3	$39.99
	AVP-H4	$39.99
	AVP-H5	$39.99
	AVP-H7	$39.99
	AVP-H8	$39.99
	TH1	$39.99
	TH2	$99.99
	TH3	$29.99
	TH4	$109.99

Sub-Total	___________
Tax (MO, CO, IL, FL only)	___________
S & H	_____ $14.95

(Applies to Domestic U.S. only. For Hawaii, Alaska, and Puerto Rico S&H will be $36.25 for 1lb and $64.25 for 2lbs or more).

Mail To:

Midland Radio Corporation Consumer Dept.

5900 Parretta Drive Kansas City, MO 64120

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Or Call 816.241.8500.

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To order online go to www.midlandradio.com

Total	$___________
Page 23	www.midlandradio.com