ORDER FORM Client Name: Physical Address Required:

Sensear Notice:

The following information should help you fill out this order form properly. This order form is to be used for: 1.) Ordering any Sensear item. a.) Fill out order form completely b.) Provide a physical mailing address (not a P.O. Box) c.) Include payment with order (Visa, MasterCard, Personal or business check)

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Sensear Systems
(Check Appropriate Boxes) Qty.
SP Earplug Model (Face-to-Face) $349.00/each ____ SP1 Earplug Model (Non-Bluetooth) $449.00/each ____ SP1x Earplug Model (Bluetooth) $549.00/each ____
Additional Items: Foam Eartips: Silicone Eartips: SPx Belt Pouch: 2.5mm to 3.5mm MP3 Cable: $29.00/Bag of 10 pairs $26.00/Bag of 10 pairs $18.00/each $20.00/each Qty. ____ ____ ____ ____ Qty.
SM Ear Muff (Face-to-Face) SM1 Ear Muff (Non-Bluetooth)** SM1x Ear Muff (Bluetooth)** SM1xSR Ear Muff (Short Range)** SMDP Ear Muff (Dual-Protection)** SM1xIS Ear Muff (Intrinsically Safe)** SGM Ear Muffs (Group Muffs, 1 Teacher/5 Student)** (Group Muffs, 1 Teacher/10 Student)**
(**Note: Boom-mic is included with unit)
$399.00/each ____ $499.00/each ____ $599.00/each ____ $799.00/each ____ $1199.00/each ____ $1499.00/each ____ *NOTE: If ordering in BULK, please contact our office for shipping costs and any further quotations necessary.
$2499.00/5pr ____ $3999.00/10pr ____
Qty. $8.00/pair $110.00/each $11.00/each $20.00/each
Additional Items: Hygiene Kit: Boom-Microphone:(not avail. SM model) Boom-Microphone Wind Sock: 3.5mm to 3.5mm MP3 Cable:

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Radio Connections $75.00/each
Motorola GP328Plus/344/388/GL2000 Motorola GP320/328/340/360/HT750/Waris Motorola HT1000/XTS Series/MTS2000 Motorola GP88/300/2000/CP100/150/450/P040/PRO3150 Motorola MOTOTRBO Motorola GM300 Dash Mount GM339/CDM1250/1550 ICOM IC-3063/4063/IC-F50/51/60/61 ICOM (2-pin) IC-F3/F35/F4 Kenwood TK-190/280/290/380/385/480/3140/3148/3180 Kenwood 2-pin Series Vertex VX-820/821/824/829/920/921/924/929
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US Shipping: UPS Ground - $15.00/package* UPS Expedited - $35.00/package* USPS International TBD
*(Bulk orders will be determined)

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If shipping by mail, ship to: E.A.R., Inc./Insta-Mold P.O. Box 18888 Boulder, CO. 80308 U.S.A. If shipping by UPS, Fed Ex, etc. E.A.R., Inc./Insta-Mold 5763 Arapahoe Ave., Unit L Boulder, CO. 80303 U.S.A. (303) 447-2619 Toll Free: (800) 525-2690 Fax: (303) 447-2637 www.EARinc.com ~ www.FreeHearingTest.com ~ Email: info@EARinc.com