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How To Order
Description Model # Price Qty. Total
Wireless Phone Jack D916 $79.95
Amplified TV Antenna ANT200 $49.95
Sales Tax
We are required by law to collect
the appropriate sales tax for each
individual state, county, and
locality to which the merchandise
is being sent.
Shipping and Handling $5.00
Total Amount Due
Name: ____________________________________________
Address: __________________________________________
City/State: ________________________________________
Zip: ______________________________________________
Daytime Phone Number: ____________________________
❐ Check Enclosed ❐ Money Order Enclosed
❐ Visa ❐ MasterCard ❐ Discover
Card Number:
■■■■■■■■ – ■■■■■■■■ – ■■■■■■■■ – ■■■■■■■■
Exp:________________
Signature: ________________________________________
To order, see your local RCA retailer. Or:
ORDER BY PHONE:
Have your Visa, MasterCard or Discover Card ready
and call the toll-free number listed below.
This number should only be used to place orders for
the above listed Accessories.
1-800-338-0376
ORDER BY MAIL:
Complete this order from and mail to:
RCA Accessories
PO Box 8419
Ronks, PA 17573
Include this completed form with your order.
Shipping and handling is charged for all orders.
Please allow 4-6 weeks for mail orders.
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