Programming Form

Please make a copy, fill it out, and send with the radio(s) to:
Radio Research Inc., 220 Finley Avenue, Staten Island, NY 10306
T.718-980-6787, 646-823-5679. Email: usa472@msn.com

Model Number: Serial Number:

Ch #

ALIAS

Receive frequency

Receive PL Code

Transmit frequency

Transmit  PL Code  Scan List Priority Channel
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Party responsible for radio equipment:

 Company:   Contact name:  Title:
Email address:  Phone #  Fax # : 
Shipping Address: 
 Billing Address:
Payment info: __ PayPal (account ID________________)  __Check __ MO __ Visa/MasterCard_#______________________ Exp. Date_______
 Additional comments:

                                       Signature:                                                                                                         Date: