Specialized Hearing Systems Order Form

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Brite Ears Specialized Hearing Systems:
Custom Electronic Order Form

Client Information


Client Name
Ship to:
Name
Address
City/State/Zip
Country
Contact
Phone

Product Information


R	L	E.A.R. Hi-fi Series (select colors and shell material below)
		Analog I
		Analog II
R	L	E.A.R. Digital Series (select colors and shell material below)
		Digital Basic
		Digital Plus
		Digital Two-Memory
R	L	Private Ears™ Wireless Communications Systems (Call for information on neck loops, two-way radios, custom and non-custom headset devices and microphones)
		Private Ear Custom - Cost:$90.00/ear
		Private Ear Micro - Cost: $170.00/ear (used in "receive only" applications)

Options


R	L	Faceplate Options
		Hunter Tan
		Red
		Blue

R	L	Shell Color
		Clear
		Red
		Blue

R	L	Venting option
		Vented (used in bow hunting or non-shooting sports)
		Non-Vented (used in shooting sports for maximum hearing protection)
		Batteries
		4 Cells - Costs: $4.00/package
		40 Cells - Costs: $35.00/box

Special Instructions


If you have any special instructions, please explain in the space provided:

Payment Method


Personal Check Company Check Visa MasterCard
Account Name
Account Number		Exp. Date /
		All orders will be sent UPS Ground unless specified above. Foreign countries, please contact us before ordering.


To submit an order, fill out this form, print it, and then either fax it, or mail it to: Brite Ears LLC P.O. Box 6358 Akron, OH 44312 USA Phone: (330) 618-8913 Fax: (330) 784-8884 Click here to go back to the order form list

For more information click Information Request Form and we will be happy to contact you.

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All Rights Reserved. Last modified: 09/29/2008