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Piconics Engineering Kit Order Form
Name:
Company:
Shipping Address:
City, State, Zip:
Telephone #:
E-Mail
Date:
Kit Information
Kit #
Part Numbers - 5 of each included in kits
Kit 1-
CC25T47K240G5
CC50T40K240G5
Flying Lead Broadband
Conical Kit
CC21T36K240G5
CC75T36K240G5
CC45T47K240G5
CC110T47K240G5
Kit 2-
CC19T40K240G5-C
CC50T40K240G5-C
SMT Broadband
Conical Kit
CC21T36K240G5-C
CC110T47K240G5-C
CC45T47K240G5-C
CC82T44K240G5-C
Kit 3-
CC21T36K240G5-B
CC25T30K240G5-X
Conicals for Higher
Power Applications
CC21T36K240G5-X
CC31T30K240G5-X
CC12T30K240G5-X
---
Kit 4-
MG3T47.018SXS-00
MG15T47.018SXS-00
High Frequency
Gold Air Coil Kit
MG5T47.018SXS-00
MG20T47.018SXS-00
MG10T47.018SXS-00
MG30T47.018SXS-00
Kit 5-
MK3T47.018SXS-00
MK15T47.018SXS-00
High Frequency
Copper Air Coil Kit
MK5T47.018SXS-00
MK20T47.018SXS-00
MK10T47.018SXS-00
MK30T47.018SXS-00
Price/ Kit
Qty
Total $
$99
$109
$99
$59
$49
Credit Card Information
Name on Card
Billing Address
Shipping Carrier / Method
Account Number
Mastercard or Visa
Credit Card Number
Expiration Date (MM/YY)
CSC Code on back of card
Fill out the entire form then e-mail it to [email protected]. You can also fax your order to 978-649-9643.
Either way a Piconics representative will get back to you with a confirmation of the order.
Shipping is not included in the above pricing and will be placed on your shipping account, if no shipping
account is entered then the shipping will be added directly to the credit card entered.
Print Form
Piconics Inc. -- 26 Cummings Rd. Tyngsboro, MA 01879-1406 -- Tel.: (978) 649-7501 -- Fax: (978) 649-9643