Name:
         Callsign:
 Shipping Address:
   Address Line 2:
             City:
            State: Zip:
          Country:
Daytime Phone No.:
Evening Phone No.:
   E-Mail Address:

           Sub Total: 
    Shipping Charges:  (see below)
5.5% Wisc. Sales Tax:  (Wi Residents only)
         GRAND TOTAL: 

Shipping charges are calculated as follows:
     * US and Canada...$ 7.00 per order
     * Overseas:.......$33.00 per order
       Important Information on International Orders