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Reference
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TM
Charge your order on your VISA,
MasterCard, or Discover Card by
filling in below
USE YOUR CREDIT CARD
IM PORTANT:Copy complete account number
from your VISA card
IM PORTANT: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)
Print or type your name and
address clearly.
A complete and correct
order will save you days
of waiting.
IM PORTANT:Copy complete account number
from your Discover Card
My card expires:
To Place an 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:
Video Accessories
PO Box 8419
Ronks, PA 17573
Name: _____________________________________________
Street: _____________________________________________
________________________ Apt. ___________________
City: ______________________________________________
State: ____________________ Zip: ___________________
Daytime Telephone No.: _______________________________
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.
15739290.08 reference 4/19/01, 4:26 PM60