RCA 16211370 manual Accessory Order Form, To Order

Accessory Order Form

To Order

To place your order by phone, have your Visa, MasterCard or Discover Card ready and call the toll- free number listed below.

Use this number only to place an order for accessory items listed on this order form.

1-800-338-0376

To place your order by mail, detach and mail the completed order form with credit card information, money order or check in US currency (made payable to Thomson multimedia Inc.) to the following address:

Here ✂

Thomson Inc.

Mail Order Department

PO Box 8419

Ronks, PA 17573-8419

	Charge your order on your VISA,
	MasterCard, or Discover Card by
	filling in below
USE YOUR CREDIT CARD
				®
IMPORTANT: Copy complete account number
	from your VISA card
	My card expires:
IMPORTANT: Copy complete account number		s	r	r	TM
	from your MasterCard
Copy Number	My card
above your	expires:
name on
MasterCard
IMPORTANT: Copy complete account number
	from your Discover Card
	My card expires:
	AUTHORIZED SIGNATURE
(Credit card order will not be processed without signature)

Print or type your name and	A complete and correct
address clearly.	order will save you days
	of waiting.

Name:

Street:

Apt:

City:

State:Zip:

Daytime phone number:

Please make sure that both sides of this form have been filled out completely.

•Allow 4 weeks for delivery.

•All accessories are subject to availability.

•Prices are subject to change.

AC power converter		Headset
5-2495		5-2425
Description	Part No.	Price	Qty Total
AC power converter	5-2495	$20.85
Headset	5-2425	$19.95
Prices are subject to change without notice.
Total Merchandise		$	_______
Sales Tax		$	_______
We are required by law to collect the appropriate
sales tax for each individual state, county, and
locality to which the merchandise is being sent.
Shipping and Handling		$	5.00
Total Amount Enclosed		$	_______
Use VISA, MasterCard, or Discover Card preferably.
Money order or check must be in U.S. currency only.
No COD or CASH.

All accessories are subject to availability.

Where applicable, we will ship a superseding model.

Detach

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