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©
2004 Audiovox Electronics Corp., 150 Marcus Blvd., Hauppauge, NY 11788
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.
1) Name:___________________________________________
2) Address:_________________________________________
3) City:________________State:________Zip Code:__________
4 Telephone Number:(
)_____________________
5) Total Number Of Transmitters Required:_______
Cost Per Transmitter is:
$65.00
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
ORDER FORM FOR TRANSMITTER AVX1B4S
128-7066