Retro-16 Pro Order Form

Equipment shipped to physical addresses ONLY.  No Post Office boxes, please.
Please verify you have selected correct unit and order form as all sales are final.

Name:_________________________________   Company:_______________________________

Day phone:_________________________________(if international, please include country code)

Email address:___________________________@______________________________________

Street______________________________________________  Apartment or Suite #__________

City:   ___________________________________  State/Province__________________________

Country _______________________________________        Postal Code (zip) _______________

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Payment method: (please circle)

PayPal         Cashier's Check         Company Check        Wire Transfer         Credit Card
 

Exact amount of payment, including shipping and any wire transfer fees $__________________
 

Date payment sent:_____________  Date payment received:___________________
                                                                                                                        (do not fill in)
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The following must be signed for your order to be scheduled.

I have read the Pre-Order Information Page
and agree with the terms and conditions stated.__________________________