Please provide the following shipping information:

Name __________________________________________ Amateur Call ___________

Address _______________________________________________________________

City ________________________________________ State/Province _____________

Zip/Postal Code ____________ Country ______ E-mail ________________________

Home Phone ________________________ Fax Phone _________________________

How did you hear about our antennas? _______________________________________

Please provide the following order information: Circle the color

____ Little Tarheel II ($379)   Black   White   Red   Silver   Blue

____ Model 40A-HP  ($389)   Black   White   Red   Silver

____ Model 40A-HP Package  ($499)   Black   White   Red   Silver  

____ Model 75A "Stubby" ($389)   Black   White   Red   Silver

____ Model 75A Package ($499)   Black   White   Red   Silver

____ Model 100A-HP ($389)   Black   White   Red   Silver

____ Model 100A-HP Package ($499)   Black   White   Red   Silver

____ Model 200A-HP ($409)   Black   White   Red   Silver 

____ Model 200A-HP Package ($519)   Black   White   Red   Silver

____ HP-6 High Power Stainless Steel 6' Whip ($45)

____ Second Station Kit ($49) _______________ (for which antenna)

____ Capacitance Hat ($69)

____ SDC-102 Programmable Antenna Controller ($130)

____ 5' Control Cable ($13.95)

____ 10' Control Cable ($17.95)

____ 20' Control Cable ($19.95)

____ 50' Control Cable ($26.95)

____ MT-1 Antenna Bracket  for the Model 100 - 400 ($119)

____ Small MT-1  Antenna Bracket for Model 75 "Stubby" ($114)

____ MT-2 Post Mount ($89)

____ MT-3 2" Receiver Hitch Mount ($89)

____ MT-3 FB 2" Fold Back Receiver Hitch Mount ($139)

____ MT-4 FB 1 1/4" Fold Back Receiver Hitch Mount ($139)

____ MT-3 OFB 2" Offset Fold Back Receiver Hitch Mount ($169)

____ MT-5 Manual Lift & Lay Mount ($149)

____ MT-6 Manual Lift & Lay Mount for Wheel Well ($159)

____ MT-10S Manual Side Rail Mount for Model 75 w/short post ($125)

____ MT-10L Manual Side Rail Mount w/long post ($129)

____ MT-11S Manual Flat Plate Rail Mount for Model 75 w/short post ($109)

____ MT-11L Manual Flat Plate Rail Mount w/long post ($119)

____ MT-12 2" Receiver Hitch Mount with 3' extension ($165)

____ Lift & Lay Motorized Lift & Lay Mount ($459)

____ Bolt-On Receiver Tube ($56)

____ 2" Receiver Tube -- 24" Long ($42)

____ 2" Receiver Tube -- 48" Long ($80)

____ Ferrite Decoupling Core ($5)

____ Matching Coil ($3) ______________

____ Whip Ferrule ($8)

____ Molex Kit ($5)

____ Manual Switch ($10)

____ 21' RG8X Coax  ($26.95)

________________ SUB TOTAL

________________ MO SALES TAX 5.925% 

________________ SHIPPING*

________________ TOTAL

*  Shipping of one antenna set up averages $30.00 inside the USA.  Little Tarheel II antenna set up averages $15.00 inside the USA. Please verify shipping costs via e-mail or phone if different than one antenna set up or out of the USA. Some areas of Texas, California, Oregon, Washington and Wisconsin seem to run a little more when it comes to shipping from Missouri, if you are in either of those states your shipping may increase as much as $10.00. 

Notes:________________________________________________________________

______________________________________________________________________

Credit Card Information (MASTERCARD or VISA)
Payment on ALL sales out of the United States use http://www.westernunion.com/ for money transfers.

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Expiration Date: _________________________ Security Code ________________

Name: (as it appears on card) __________________________________________