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1)Pad Number:_________________________________
2)Name: _______________________________________
3)Address: ______________________________________
4) City: ________________ State: _____ Zip Code: ________
5) Telephone Number: (_____) _______________
6) Total Number Of Transmitters Required:
Cost Per Transmitter is: $65.00
Multiply By Number Of Transmitters X ______
7) Enter Total Amount Enclosed _________________
(New York State Residents must include the appropriate sales tax)
8) 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: ____ / _____ / _____
9) Mail this form along with your payment to:
ORDER FORM FOR AX-2K4 AX-2K4S, AX-2K4MS, AX-2K4MSFL
Audiovox Electronics Corp., 150 Marcus Blvd., Hauppauge, N.Y., 11788
Attn.: TRANSMITTER DEPARTMENT
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.
128-6987
© 2003 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 infor-
mation legibly and mail this form
and your payment 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.
AX-2K4MSFL Main use PD 110, Side use 111