Accessories Order Form
Please send Money Order or fill in the Visa/Master Card 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:__________
Telephone:___________________________________________________________Email:____________________________
CC#_________________________________________________________________ Type:_________Exp:________________
| QTY |
| ITEM |
| PRICE | TOTAL |
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| XTA101 |
| $29.99 |
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| XTA102 |
| $19.99 |
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| XTA103 |
| $19.99 |
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| XTA104 |
| $14.99 |
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| XTA105 |
| $19.99 |
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| XTA106 |
| $19.99 |
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| XTA107 |
| $19.99 |
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| XTA108 |
| $19.99 |
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| XTA301 |
| $29.99 |
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| ____________________ |
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| Tax (MO, CO, IL, FL Only) |
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| ____________________ |
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| S&H |
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| $14.95_______________ |
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| (Applies to Domestic US only. For Hawaii, Alaska, and Puerto Rico S&H will be $38.25 for 1 lb | ||||||
| and | $64.25 for 2lbs or more). |
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| Total |
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| $____________________ |
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| Mail To: |
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| Midland Radio Corporation |
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| Consumer Dept. |
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| 5900 Parretta Drive |
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| Kansas City, MO 64120 |
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| ______________________________ |
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| Or Call 816.241.8500 |
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| ______________________________ |
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| To order online go to |
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| www.midlandradio.com |
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16 |
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| www.midxtc.com |
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