GE 21095GE2 User Guide - Page 61

ACCESSORY ORDER FORM ✂ CUSTOMER: CUT ALONG DOTTED LINE. DESCRIPTION AC power adapter Headset Belt Clip Replacement Handset Battery MODEL NUMBER Black 5-2605 5-2555 5-2607 5-2548 White 5-2606 5-2552 PRICE* QTY. To order, call 1-800-338-0376 (for accessories only) or complete this order form. For credit card purchases *Prices are subject to change without notice. TOTAL Your complete charge card number, its expiration date and your signature are necessary to process all charge card orders. Copy your complete account number from your VISA card. My card expires: Copy your complete account number from your Master Card or Discover. 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. Duties will apply for shipments to Canada. Use VISA or Master Card or Discover preferably. Money order or check must be in U.S. currency only. No COD or Cash. All accessories are subject to availability. Where applicable, we will ship a superseding model. Shipping/Handling 5__.0_0______ Total Amount Enclosed Copy the number above your name on the Master Card My card expires: Mail order form and money order or check (in U.S. currency) made payable to Thomson to: Thomson Mail Order Department P.O. Box 8419 Ronks, PA 17573-8419 61 Authorized Signature Please make sure that this form has been filled out completely. Name Address Apt City State________ ZIP Daytime Phone Number