User guide

FAX OR MAIL
HEAR-MORE
P.O. Box 3413, Farmingdale, NY 11735-0686
Voice. 1-800-881-4327 TTY. 1-800-281-3555
Videophone. 631-752-1145 Fax. [phone]
[e-mail]
PAYMENT INFORMATION
You can charge my order to my:
O Discover O Visa O Master Card O American Express
ACCOUNT # ________-________-________-________
EXPIRATION DATE _____/_____/_____
x_______________________________________
AUTHORIZED SIGNATURE
DATE _____/_____/_____ PHONE # ______________
ORDER IS VALID ONLY WITH AUTHORIZED SIGNATURE AND PHONE NUMBER
THANK YOU FOR YOUR ORDER!
SHIPPING CHARGES
If your order totals
ADDITIONAL INFORMATION
Authorization must be obtained for all returns. Shipping charges
are not refundable. Additional shipping charges on items where
indicated. Shipping to Alaska, Hawaii, Puerto Rico & V. Islands
require additional charges that will be added to your invoice.
Sometimes we may be out of stock, please check if you would like
us to:
O Hold for BO; ship entire order complete
O Ship in-stock items now; ship BO when possible
O Ship in-stock items now; cancel BO
BILLING INFORMATION SHIPPING INFORMATION
FIRST NAME__________________________________
MIDDLE INITIAL_______________________________
LAST NAME__________________________________
ADDRESS____________________________________
CITY________________________________________
STATE_______________________________________
ZIP CODE____________________________________
E-MAIL_______________________________________
DAYTIME PHONE/TTY__________________________
O Check here if your address has changed since your last order.
Complete, if different from billing information
FIRST NAME________________________________
MIDDLE INITIAL_____________________________
LAST NAME________________________________
ADDRESS__________________________________
CITY_______________________________________
STATE_____________________________________
ZIP CODE__________________________________
E-MAIL_____________________________________
DAYTIME PHONE/TTY________________________
ORDER INFORMATION
ORDER FORM
ITEM #
EACH
TOTALQUANTITY
IMPORTANT: If you are claiming tax exemption, please provide a copy of your Exemption Form or Resale Certificate.
NEW YORK STATE RESIDENTS PLEASE Add applicable Tax on taxable items.
TOTAL AMOUNT
ADDITIONAL SHIPPING CHARGES - As listed per item
PRODUCT NAME
SHIPPING CHARGES - See chart below
Check the box to order additional catalog
HEARMORE 2011/12
$15 or less add $5.90
$15.01-24.99......$7.50
$25-49.99...........$7.90
$50-99.99...........$9.90
$100-149.99.......$12.90
$150-199.99.......$13.90
$200-249.99.......$15.90
$250-299.99.......$17.95
$300-2000..........$18.95
$2000+ add $10 for each
$1000
Additional charges indicated
when applicable
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