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ORDER FORM
For credit card orders fill out order
form and fax to: 773.622.2269
or call 773.889.3087
(Press 1 from the main menu)
8:00 am - 6:00 pm, M-F, CST.
Make check or money order
payable to:
Cobra Electronics
6500 West Cortland Street
Chicago, IL 60707 USA
Attn: Accessories Dept.
To order online,
please visit our website at:
www.cobra.com
and click “shop Cobra
®
”
Prices subject to change without notice.
Tax Table
Illinois residents add 8.75%
Indiana residents add 5%
Michigan residents add 6%
Ohio residents add 5%
Wisconsin residents add 5%
Please print clearly
Name
Address (No P.O. Box)
City State
Zip
Telephone ( )
Credit Card No. Exp. Date
Circle One: Visa MasterCard Discover
Customer Signature
Allow 2-3 weeks for delivery. Offer valid in Continental U.S. only.
420-030-N-001 Straight 12V Power Cord
420-026-N-001 Curled 12V Power Cord
545-139-N-001 Windshield Mounting Bracket
xxx-xxx-N-001 Dual Port Power Adapter
Item # Description Cost Ea. Qty. Amount
Subtotal
(Tax if applicable)
Shipping/handling $4.00
Total