128-6799A
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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.
Be certain to specify
MODEL NUMBER
found on back of your transceiver___________
1) Name:___________________________________________
2) Address:_________________________________________
3) City:________________State:________Zip Code:__________
4 Telephone Number:(
)_____________________
5) Total Number Of Transmitters Required:_______
Cost Per Transmitter is:
$85.00
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
Credit Card Number:___________________________________
Credit Card Expiration Date: ____/___/____
8) Mail this form along with your payment to:
Transmitter Ordering Department
Audiovox Corporation 150 Marcus Blvd., Hauppauge N.Y. 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
7
ORDER FORM FOR TRANSCEIVERS 5BCR & 5BCR03
5BCR/5BCR03
5BCR05
