Name (please print)_________________________________________________________

Address ____________________________________________________________________

City ______________________ St./Prov. ________________ Zip Code ____________

Country (if not USA) __________________ Phone _____________________________

Email address __________________________________________________________

SHIPPING/HANDLING CHARGES:

Note: Payment must be in U.S. dollars, drawn from a U.S. bank.

Make checks payable to "Micronet Technologies".

Phone: (616)583-1990

All prices subject to change without notice. All items subject to availability.

Thank you!