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Submit this form along with payment (Check or Money order) to:

Auto-Mate Systems

P.O. BOX 695

Stayton, OR 97383

For COD orders, FAX form to 253-669-3214 or call 503-769-2886

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Name:_________________________

Company Name: ____________________________

Call Letters/Station Name: __________________________

Address*: Street/Box:___________________________

City:______________ State:______ Zip:________

Phone:_______________ Fax:________________

E-mail: ___________________________________

* For non-postal service delivery, a street address must be included.

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Item i.d. Quantity Description Price

________ ____ __________________________________ $__________

________ ____ __________________________________ $__________

________ ____ __________________________________ $__________

________ ____ __________________________________ $__________

Total Enclosed--->$__________

For overnight shipping, please see order Pricing Page, and enter item # and price above.