--- Black Cat Systems USB CI-V Interface CHECK / MONEY-ORDER ORDER FORM --- Please print and fill out this order form, and include with your payment Qty Item Each Total ____ USB CI-V Interface $59.00 ___________ ____ USB CI-V 2 Port Interface $69.00 ___________ ____ USB CI-V 4 Port Interface $89.00 ___________ Shipping ($10.00 US, $30.00 elsewhere, this includes Canada) ___________ Maryland Residents add 6% sales tax ___________ Total ___________ All prices are in US dollars. Payment must be either a US Postal or International money order, or a US check drawn on a US bank. Checks held until cleared. Your shipping address: Name: _________________________________________________________________ Address: ______________________________________________________________ City: ________________________________ State: _________________________ Zip or Postal Code: __________________ Country: _______________________ Email address: ________________________________________________________ Including your email address is VERY important as this is how we will contact you with any questions regarding your order. Please make checks and money orders out to: Black Cat Systems Mail This Form To: Black Cat Systems 4708 Trail Court Westminster, MD 21158 USA -------------------------------------------------------------------------