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48
Charge yourorderortyourVISA,
MasterOard,
or Discover C ardby
filling inbelow
USEYOURCREDIT CARD
IMPORTAR I:
OopycorTiplutc a ccount number
from yourVISAcard
VISA"
FT-N
NT-N F-n
F-n
f_ycardu×pircs: _
IMPORTART:
0opy completeaccount number
from your Megter0ard
r-FNq r-FNq r-FNq r-FNq
0opy Ndmbor
ebovuyour
[laffl_ or1
Megt¢r0ard
"_Yp'rd I I IIII
¢xpvus:
IMPORTANT:
Copycompleteeccouut numbor
from your DiscovurCard
r-FNq r-FNq r-FNq r-FNq
Myuard expires: [--[--]
[--[--]
AUTHORIZEDSIGNATURE
(Credit card order will not be processed without signature)
Print or type your nameand
/
A completeandcorrect
addressclearly.
_
order will saveyou days
of waiting.
Name:
Street:
Apt:
State;
Zip:
Daytimephonenumber:
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.
.{2
Split:or VH47
2-way St,gnat Splitter
lle[_')_
connect a *_ond TV
or V(TR.
CRK76TTL1
R_ole
Conl_l
TbLs"is the remo_
conrad
tlaat
came packed
with your
'IV/
VCJ_. R_lacet_k_'
or *2_are*
can ._. ordered
as" needed,
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 fllis 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 marl the
completed
order form with credit card [nfomaation,
mone 7 order or check LnUS currency (made
payable to Thomson
moltLmedia inc.) to the
follo_d ng address:
Video
Accessories
PC Box
8419
Ronks,
PA 17573
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