LowPriceWireless.com
OFFICIAL ORDER FORM

You've selected the following pager:
Mitsuki Capture
Color: Black / Black
To Complete Your Order Follow the Following Steps

STEP 1 :

Select a payment option:

$79.95 - Mitsuki Capture with 3 months premium service (scroll to select annual payment pkg.) Select Payment Option - $136.50 - Mitsuki Capture with 1-Full Year premium service (Save $24)

Price includes shipping & handling, and sales tax where applicable.

STEP 2 :

Tell us the area code to be activated for your pager service:

(example: 702-Las Vegas)

STEP 3 :

Tell us who you are and where to send your new pager:

Name
Title (if applicable)
Company
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
E-mail
FAX

STEP 4 :

Please enter your credit card information:

Credit Card	VISA MasterCard American Express Discover
Cardholder Name
Card Number
Expiration Date

** Premiere paging service includes wide area coverage throughout Las Vegas, Nevada, Southern California, with VoiceMail.   Premiere paging service will be billed quarterly at a rate of $8.95/mo, or annually at a rate of $6.95/mo.  Initial 3 months service pays for first, second and last month of paging service.  See Paging Agreement for further details.

Please ship my pager ASAP.