Mail Order Form

North Country Radio - Mail Order Form

USA and CANADA orders only

Other Nations please use online secure order form

Name: Shipping Address:

City or Town: State or Province:

Zip or Postal Code: Country:

Telephone: Fax:

Email:
Method Of Payment (Check One):

Visa Check Money Order Other

MasterCard

If Credit Card (MC/Visa)CC Number: Exp Date:

Security Digits (Located on back of credit card, 3 digit number, to right of signature)

Orders will be shipped on receipt of payment

ITEMS ORDERED

QTY PRODUCT DESCRIPTION PRICE EA. ($USD) TOTAL ($USD)

$

$

$

$

$

$

$

$

Subtotal

$

NY State Residence add 8.25% sales tax

$

Postage and handling (USA orders only)

$10.00 First Item + $1.00 Each Add'l Item

$

Postage & Handling (CANADA)

$15.50 First item+ $4.50 Each Add'l Item

$

Total Amount

$

Send this completed form with payment to:

North Country Radio

PO Box 200

Hartford, NY USA 12838-0200

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NORTH COUNTRY RADIO

PO Box 200, Hartford NY 12838-0200

EMAIL: support@northcountryradio.com Tel 518-854-9280 Internet http://www.northcountryradio.com

Name:	Shipping Address:
City or Town:	State or Province:
Zip or Postal Code:	Country:
Telephone:	Fax:
Email:	Method Of Payment (Check One):
	Visa	Check	Money Order	Other
	MasterCard
If Credit Card (MC/Visa)CC Number:				Exp Date:
Security Digits (Located on back of credit card, 3 digit number, to right of signature)

ITEMS ORDERED
QTY	PRODUCT DESCRIPTION	PRICE EA. ($USD)	TOTAL ($USD)
		$	$
		$	$
		$	$
		$	$
Subtotal			$
NY State Residence add 8.25% sales tax			$
Postage and handling (USA orders only) $10.00 First Item + $1.00 Each Add'l Item			$
Postage & Handling (CANADA) $15.50 First item+ $4.50 Each Add'l Item			$
Total Amount			$