Centaur Electronics, Inc.
Order Form
To order by Fax, print this form, fill it out and Fax it to (520) 579-1766
Name on Credit Card:________________________________________
Address: _______________________________________FedEx can not deliver to P.O. Boxes
City ______________________________________ Daytime Phone _______________
State, Zip: ________________________________ Company _____________________
Type of Card: (Circle One) Visa Master Card American Express
Credit Card Number: _____________________________________ Expiration Date: __________
Signature: _______________________________________
Product Price Shipping X Qty. = Total
B11W10-50 1:1 Dipole Balun $99.95 + $6.75 X ____ = $________
B41LW10-50 4:1 Ladder Line Balun $129.95 + $6.75 X ____ = $________
Big Bertha 1:1 Dipole (Standard) $295.00 + $9.95 X ____ = $________
Big Bertha 4:1 Ladder Line
(Standard)
$395.00 + $9.95
X
____ =
$________
Specify Frequency
Arizona Residents applicable
Tax $________
Total $________
Shipping will take 7 to 10 days. Orders will be shipped
FedEx Ground.
All prices are in $US. Shipping prices
apply to the lower 48. Orders outside the United States will pay actual
shipping.