CRYSTALS Order Form

You can fill out this order form while online and then print it for mailing or you can save it to your computer, using your computer's "Save As" command, so you can fill it out, print it and mail it at your leisure. Orders and payment are accepted by mail with this form, or by credit card. Please make payment by money order or check.  Paypal and credit cards are also accepted using all major cards.   If your delivery address is outside the 50 US states, contact me for shipping amount before ordering.  Crystals are guaranteed for 14 days after shipment. Should ANY crystal fail, the return shipment for a replacement is at your expense.  This form is for our standard available frequencies only. No custom crystals. Please write clearly.   Questions?   Call 321-262-5471.   

Please WRITE LEGIBLY, and  make your payment to "Brian Carling." Mail this order form to: 

Brian Carling, AF4K CRYSTALS
117 Sterling Pine Street
Sanford, FL 32773-7428

Order Date:
Ship To Name:
Address:
City and State:
Zip Code:
Phone: 
Email Address: 

I will use:  (mark one)  CHECK:____      MONEY ORDER: ____  
CREDIT CARD: ____      PAYPAL: ____
CREDIT CARD TYPE: ______________________________________
ACOUNT NUMBER: _______________________________________
EXPIRATION: _____________________________________________
NAME ON CARD: __________________________________________
BILLING ADDRESS: ________________________________________
3-DIGIT CCV CODE ON BACK: ______________________________

Enter my order for the following RADIO CRYSTALS - Type FT243 at $20.00 USD each. Type FT171B at $29.00 each.   Type hc6u at $24.00 each.   Type hc49 at $12.00 each.

Frequencies (Please choose from published AVAILABLE FREQUENCIES ONLY)
TYPE  -  QTY  x  FREQ

_________________________ = TOTAL $ ____________

_________________________ = TOTAL $ ____________

_________________________ = TOTAL $ ____________

_________________________ = TOTAL $ ____________

_________________________ = TOTAL $ ____________
Regular First Class USPS Mail to any of the 50 USA states is $7.00 for any quantity, Please e-mail us for shipping cost to other areas before ordering.
Insured US Postal Service, Priority Mail shipping to any of the 50 US states is: $15.00. Please e-mail us for shipping cost to other areas before ordering.
        
TOTAL CRYSTALS:  $ ______________
Shipping and Handling:  $ ______________
Total Enclosed:              $ ______________
We appreciate your order.  Brian Carling, AF4K Crystals