Fill out this form and the form on the previous page
to print for mail in orders.
NAME:__________________________ CALLSIGN________________
STREET:____________________________________________________
CITY:_______________________________________________________
STATE:_________ POSTAL CODE _________ Country____________
PHONE:_______________________________
VISA/MC/AMEX # __________________________________________
EXPIRES:_________ SIGNATURE_____________________________
E-MAIL ADDRESS ___________________________________________
ARE YOU CURRENTLY ON ATV ? _____ YES _____ NO
ARE YOU CURRENTLY ON SSTV ? _____YES _____ NO
DO YOU USE AN ATV REPEATER ? _____ YES _____ NO
CALL OF THE REPEATER _________ LOCATION ______________
REPEATER HAVE A WEB PAGE ? http:// ______________________
ATVQ, 5931 Alma Dr., Rockford, IL 61108 - PHONE: 815-398-2683
ORDERS TO ATVQ 1-815-398-2683
>>FAX 815-398-2688<< >>>> E-MAIL ATVQ@hampubs.com
