BuzzerSystems.com - 2,3,4 Player Buzzer System Order Form

Order Form: 4-in-1 Buzzer Lockout System
Prices effective: January 1, 2008 This is not an on-line order form! Please print this form then fill out by hand.

FAX or mail order to:	Ship to:
Novel Electronic Designs. Inc. 143 N. Third Street Chillicothe, IL 61523-2156	Company or School:
	Contact Name:
	Street Address:
Fax 309-274-8454 Please call 309-224-9945 to confirm we received your fax!
	City, State, ZIP:
	Daytime Phone:
We try to ship next business day, but please allow one to two days for processing. Thank you!
	Email Address:
	Payment Method (select one) info
	Purchase Order #:	Credit Card (include form)	Check Enclosed
	Tax Exemption Number : Illinois Customers Only

4-in-1 Buzzer Lockout Console info
Lockout Console for 2, 3, or 4 players *Includes: power pack and 1-year warranty!*	$125	QTY ________	TOTAL $_______
Accessories & Options
Timer (handheld) Model TIMER-1	$15	QTY ________	TOTAL $_______
Pushbutton Special Price when purchased with console! Hand-held button (same button used with our larger buzzer systems)	$5 limit 4 per console!	QTY ________	TOTAL $_______
Slam Switch Industrial activator switch. Hit it with your hand or step on it with your foot! Plugs directly into console. Can be used by one or more players.	$25 each	QTY ________	TOTAL $_______
Pushbutton & Slam --- 15ft Cable Extender Extends the 5ft cable on the handheld and slam button an extra 15 feet!	$4 each	QTY ________	TOTAL $_______
Multi-System Cable/Connector Kit (for 2 or more systems) Includes 15ft cable and 2-way connector, allowing you to connect two 4-in-1 consoles to each another. Model MULTI-CABLE	$10	QTY ________	TOTAL $_______

International Orders - for customers outside USA and Canada Add $20 for each system. Power your system from voltages ranging from 100 to 240VAC (the base system is powered from 120VAC only) Click here for details. Power cord not included.			$_______
Carrying Case *High-quality B*allistic Nylon case for the 4-in-1 and all its accessories.	$25	QTY ________	TOTAL $_______