Audiovox 105BP manual Method of Payment

ORDERFORMFOR 105BP Transmitter

Attention: Transmitter Ordering Department

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.

Indicate the pad number of your transmitter selected from the pads shown above.

Note: Transmitter model number found on back of case.

1)Name: _______________________________________

2)Address: ______________________________________

3)City: ________________ State: _____ Zip Code: ________

4)Telephone Number: (_____) _______________

5)Total Number Of Transmitters Required:

Cost Per Transmitter is:	$75.00
Multiply By Number Of Transmitters	X ______

6) Enter Total Amount Enclosed _________________

(New York State Residents must include the appropriate sales tax)

7)Method of Payment:

Mastercard Visa Check or Money Order (do not send cash) Make Checks Payable To Audiovox Corporation

CreditCardNumber:

_________________________________

Credit Card Expiration Date: ____ / _____ / _____

8) Mail this form along with your payment to:

transmitters by phone. Simply dial 1 - 800 - 645 - 4994, and follow the instructions from the operator interface.Credit card purchasers can order additional or replacement

Audiovox Electronics Corp., 150 Marcus Blvd., Hauppauge, N.Y., 11788

Attn.: TRANSMITTER DEPARTMENT

7

128-8777

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