General Extension ORDER FORM

Use your credit card or send a check or money order for $495 to Radio Mall, 2412 Unity Ave. N., Dept. EXTW, Minneapolis, MN, 55422, USA. MN residents, please add sales tax. All payments must be in U.S. funds. Free shipping in the U.S. and Canada. Foreign order, please add $70 for shipping.

Name_________________________________________ Company ___________________________________

Street Address______________________________________________________________________________

City, State, Zip___________________________________________ Country___________________________

Phone________________________ FAX________________________ E-Mail__________________________

How you found us__________________________________________________________________________

(verified members only)

Click here for PayPal instructions.

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Card#__________________________________ Exp. Date______Signature_____________________CCID_____

For credit card orders, phone or FAX 763-522-6256 or 800-759-4561.