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Please
Print this form and mail or fax it to us.
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| Check
One: |
| Visa ____
Master Card _____ Payment enclosed _______________________________________ |
| Card #_____________________________CCV# (3 digit security number)_______________ |
| Expiration date
__________________________________________________________________ |
| Name on Card ___________________________________________________________________ |
| Signature _______________________________________________________________________ |
| Breed of Mare ___________________________________________________________________ |
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| Ship To Name:___________________________ |
Name as it appears on card:_________________________ |
| Ship To Address:_________________________ |
Bill To Address:___________________________________ |
| Street:_________________________________ |
Street:__________________________________________ |
| City:________________
State:____ Zip: |
City:_________________ State: ________________ Zip: |
| Country:_______________________________ |
Country:_____________________________________ |
| Phone:_____________________________ |
Phone:___________________________________ |
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QTY
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Price
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Description
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Total
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$460.00 |
Repeater, one transmitter/pouch, one antenna |
$____________ |
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$105.00 |
*Pocket Pager |
$____________ |
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$32.00 |
*Large Antenna (17' coax cable) |
$____________ |
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$15.00 |
*Additional 20' Coax with coupler
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$____________ |
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$109.00 |
Additional Transmitter/Pouch |
$____________ |
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$90.00 |
Telephone
Auto Dialer |
$____________ |
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$20.00 |
Leather Pouch |
$____________ |
| No limit on number of pagers or transmitters used per system |
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| Pocket pager able to monitor up to 3 barns - ask for details |
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*If using pocket pager you need to order the large antenna to connect to repeater. This antenna send the signal to the pager. If additional length is needed you can order additional 20' cable with connector. Large antenna is not needed if only adding the auto dialer.
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| Transmitter Serial Number___________________________________ |
| Pager Serial number________________________________________ |
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Freight will be added to all orders
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$_______________ |
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1-541-582-2101