DIRECTIONS FOR FORM USE
Fill out form below
When you get your confirmation: Print 2 copies
Put one copy in box with radio
Keep one copy for your records.
Thank you, Rugged Bug
Install Repair
YOUR Radio Information
AMPLIFIER AMPLIFIER - FOOT WARMER AMPLIFIER - KICKER ECHOE BOARD MICROPHONE - BASE MICROPHONE - MOBILE POWER SUPPLY RADIO - BASE RADIO - EXPORT RADIO - HIGH POWER RADIO - MOBILE RADIO - 10 METER SWR METER ASTATIC BOOMER COBRA CONNEX DOSY FRANCIS GALAXY K - 40 MACO PALOMAR PYRAMID SOLARCON SUPERSTAR TEXAS STARR TURNER UNIDEN WILSON
Model Number: Serial Number:
Tell us exactly what problems you are experiencing, or what you would like added to your radio, or what you want your radio to do.
above text box has 999 word limit
Your Contact Information
Real Name Handle
Address:
City: State: ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MASSACHUSETTS MARYLAND MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
Zip Code:
Phone Number: Cell Phone:
Tell us here any other comments you may have forgotten to mention above, Thank you.
above text box has 100 word limit
Thank you for your time, this will help us prepare for your radio before it arrives. We hope that this will make service run more efficiently.
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This site was last updated 05/18/03