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

Shipping Information: (no PO boxes)
---------------------
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:	
   Echolink Password:	
Echolink Description:	

Hardware Options:
-----------------
     1RU Rackmount	NO
6 to 24V DC Option	NO
     TV Out Option	NO

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


GST @6% will be charged on all Canadian Orders
PST @7% will be charged to BC Residents

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