Order Form

This is not ORDER ONLINE

You may print this ORDER FORM and mail it with your Check or Money Order.

MAIL TO :
Adco Hearing Products
4242 South Broadway
Englewood, CO 80113

Please check ORDER INFORMATION for placing your order

ORDERED BY: Note - UPS does not deliver to P.O. Box addresses

Name:

Address:

City:

State:

Zip Code:

Country:

Daytime Phone with Area Code:

Voice TTY

Evening Phone with Area Code:

Voice TTY

Fax with Area Code:

E-Mail:

SHIPPED TO: Complete only if address is different than ORDERED BY shown above

Name:

Address:

City:

State:

Zip Code:

Country:

Daytime Phone with Area Code:

Voice TTY

Evening Phone with Area Code:

Voice TTY

METHOD OF PAYMENT:

Personal Check (allow 2-3 weeks to process orders paid by personal check.)

Money Order

Qty

Item No.

Item Description

Color/Size

Price Each

Total Price

Subtotal

CO Residents - Add 7.85% Sales Tax

Shipping & Handling - See Chart Below

TOTAL

Shipping and handling costs for continental U.S. only,
Alaska, Hawaii and all others - please call for quote.