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ORDER FORM FOR XR91 Transmitter
Attention: Transmitter Ordering Department
Important: To help us expedite your order, please print all of
the information legibly and mail this form and your pay-
ment according to the instructions below.
Indicate the pad number of your transmitter selected from
the pads shown above.
Note: Transmitter model number found on back of case.
1) Name: _______________________________________
2)Address: ______________________________________
3) City: ________________ State: _____ Zip Code: ________
4) Telephone Number: (_____) _______________
5) Total Number Of Transmitters Required:
Cost Per Transmitter is:
Multiply By Number Of Transmitters
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
CreditCard Number: _________________________________
Credit Card Expiration Date: ____ / _____ / _____
8) Mail this form along with your payment to:
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.
Audiovox Electronics Corp., 150 Marcus Blvd., Hauppauge, N.Y., 11788
Attn.: TRANSMITTER DEPARTMENT
$75.00
X ______
7
128-7860
7 of 8
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