Order Name/Callsign:
--------------------
First Name:
 Last Name:	
  Callsign:	
Email Addr:

Shipping Information: (Postal Address - PO Boxes okay)
---------------------
Address:	
Address:	
   City:		
  St/Pr:		
 Postal:		
Phone #:	

Order Information: (please send separate forms for multiple units)
------------------
   Node Callsign:		
Node# to Replace:	

Optional EchoIRLP Configuration:
--------------------------------
   Echolink Callsign:			(Must be -L or -R account)
   Echolink Password:			(All UPPERCASE)
Echolink Description:			(Freq, PL tone, coverage area)

Hardware Options:
-----------------
     1RU Rackmount	
6 to 24V DC Option	

Payment Form :	
--------------	
CHECK
or
PAYPAL/CREDIT CARD (3% payment handling fee)


GST/HST will be charged on all Canadian Orders

Special Requests: (please identify any special request here)
-----------------