Your name as it
appears on your
credit card:
Your billing address
City:
ST
ZIP CODE
Telephone
ORDER YOUR ONE VOICE BUTTON(S)
TOTAL DUE
@ $1.00 each =
TOTAL QTY OF BUTTONS
(Enter qty.  of each type below)
Please note that a $1.50 shipping & handling will be added to every order.
QTY
QTY
QTY
Button #5
QTY
Button #7
Button #3
Button #1
Button #2
QTY
QTY
Button #4
QTY
Button #6
Button #8
TYPE OF CREDIT CARD
MASTERCARD, VISA,
AMERICAN EXPRESS
CREDIT CARD NUMBER
Expiration date
(mm/dd/yyyy)
3 or 4 digit security
code on back of card
THANK YOU FOR SUPPORTING THE ELC !
Button #4
Button #1
Button #7
Button #8
Button #5
Button #2
Button #6
Button #3
MAILING ADDRESS:
7921 Deer Run Road
Glenside, PA 19038

phone 267-287-8357
fax       215-948-3398
QTY
All rights reserved.