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                ORDER FORM

Name _____________________________ Call _______
Address ___________________________ Apt _______
City ______________________________ State ______
Zip Code ______________ Phone _________________
Country _______________ E-mail _________________

QtyModelDescription Price EachExt. Price
     
     
     
     
     
     
     
     
     
     
     
     
Shipping and Handling Calculation
 Sub-Total 
Nbr of connectors ____ X 0.75 = _____ Illinois Residents add 6.5% Tax 
Nbr of LMTs....... ____ X 2.00 = _____ .
Nbr of Antennas.. ____ X 5.00 = _____ Shipping & Handling 
Nbr of Calculators ____ X 0.75 = _____ Total