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Charge your order on your VISA,
MasterCard, or Discover Card by
filling in below
USE YOUR CREDIT CARD
IMPORTANT: Copy complete account number
from your VISA card
IMPORTANT: Copy complete account number
from your MasterCard
My card expires:
My card
expires:
Copy Number
above your
name on
MasterCard
AUTHORIZED SIGNATURE
(Credit card order will not be processed without signature)
Name:
Street:
Apt:
City:
State:
Zip:
Print or type your name and
address clearly.
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.
A complete and correct
order will save you days
of waiting.
IMPORTANT: Copy complete account number
from your Discover Card
My card expires:
Daytime phone number:
AC power converter 5-2495 $20.85
Headset 5-2425 $19.95
AC power converter
Description
Price
Part No.
Qty
Total
All accessories are subject to availability.
Where applicable, we will ship a superseding model.
Prices are subject to change without notice.
Total Merchandise.................................................................
Sales Tax...................................................................................
We are required by law to collect the appropriate
sales tax for each individual state, county, and
locality to which the merchandise is being sent.
Shipping and Handling........................................................
Total Amount Enclosed........................................................
Use VISA, MasterCard, or Discover Card preferably.
Money order or check must be in U.S. currency only.
No COD or CASH.
$_______
$_______
$_______
$_______
Headset
5.00
5-2495
5-2425
Accessory Order Form
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 this 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 mail the completed order form with credit card information,
money order or check in US currency (made payable to Thomson multimedia Inc.) to the following
address:
Thomson Inc.
Mail Order Department
PO Box 8419
Ronks, PA 17573-8419
Detach Here ✂