TTYs (Text Phones)

Contact Information:

4242 South Broadway

Englewood, CO 80113

Phone: (800) 726-0851

Phone: (303) 794-3928

Fax: (303) 794-3704

sales@adcohearing.com


This is not ORDER ONLINE

You may print this ORDER FORM to place your order

Please check ORDER INFORMATION for placing your order
ORDERED BY: Note - UPS does not deliver to P.O. Box addresses
Name:
Address:
City: State or Province:
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 or Province:
Zip Code: Country:
Daytime Phone with Area Code: Voice TTY
Evening Phone with Area Code: Voice TTY
PAYMENT BY:
- - - Expiration Date: Mo. Yr.
Type name exactly as it appears on credit card:
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 & HANDLING CHARGES

Order Total UPS Ground
Up to $30.00................. $6.50
$30.01 - $50.00............. $7.50
$51.01 - $100.00........... $8.50
$100.01 - $150.00.......... $9.50
$150.01 - $250.00.......... $10.50
$250.01 - $300.00.......... $11.50
$300.01 - $350.00.......... $12.50
$350.01 - $400.00.......... $13.50
$400.01 - $450.00.......... $14.50
$450.01 - $500.00.......... $16.50
If over $500, please call!


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