EAR GEAR CUSTOM ORDER FORM

FM Corded

$31.95

FM Cordless

$30.95

FM Mono

$30.95

Micro Corded

$31.95

Mini Square Corded

$31.95

FM Eyeglasses Cordless

$38.95

Micro Cordless

$30.95

Mini Square Cordless

$30.95

FM Eyeglasses Corded

$41.95

Micro Mono

$30.95

Mini Square Mono

$30.95

Cochlear Corded

$38.95

Micro Eyeglasses cordless

$38.95

Mini Square Eyeglasses Cordless

$38.95

Cochlear Cordless

$34.95

Micro Eyeglasses corded

$41.95

Mini Square Eyeglasses Corded

$41.95

Cochlear Mono Corded

$34.95

Mini Curved Corded

$31.95

Original Corded

$31.95

Cochlear Eyeglasses Cordless

$41.95

Mini Curved Cordless

$30.95

Original Cordless

$30.95

Cochlear Eyeglasses Corded

$45.95

Mini Curved Mono

$30.95

Original Mono

$30.95

Baha Corded

$38.95

Mini Curved Eyeglasses cordless

$38.95

Original Eyeglasses Cordless

$38.95

Baha Mono

$34.95

Mini Curved Eyeglasses corded

$41.95

Original Eyeglasses Corded

$41.95

Baha Cordless

$34.95
Pricing reference chart

Your Order: Simply fill in the form below, choosing sleeve / cord / o-ring / and plastic clip OR metal clip color.

View all colors, materials,

cords, clips, and O-Rings on
our Custom Reference Chart

(www.gearforears.com/custom)

Fabric Sleeve Colors:

Cord Colors:

Beige, Black, Brown, White Beige, Black,

Brown,
DarkPurple, Forest Green,
Purple, Grey,
Grey, Lavender, Dalmation,
L.Pink, Orange, Lime Green, Lipstick Pink,
Orange, Red, Royal
Orange/Red, Red, Rainbow,
Blue, Sky Blue,
Royal Blue, Sky Blue, Teal,
Teal, Yellow
Yellow, Zebra, Jungle Green

sleeve color

Model

O-ring Colors:

Clip Colors:

Beige, Black,
Brown,

Plastic Clip Colors:

Grey, Lipstick
Pink, Red, Royal
Blue

Red, Royal Blue

Metal Clip Cover Colors:

or

Green, Grey, Brown, Lavender, L. Pink, Orange, Red, White, Rainbow,

Orange/Red, R.Blue, S.Blue, Teal, Yellow, Zebra, J. Green, L.Green, Dalmation

cord color

o-ring color

plastic clip color metal clip cover color

Price

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OR
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Subtotal:
CANADIAN RESIDENTS: Please add applicable taxes for your Province:
Shipping & Handling: Please add $7.00 for North America or $12.00 for International:
TOTAL:
2

Payment Method: Fill in your payment information.

Credit Card

Cheque

Mastercard

Visa

Your Mailing Address: Fill in your mailing address below.

Money Order

Name

American Express

Email

Cardholders Name

Street Address

Card Number

City

Expiry: Month
4

Year

Phone

Country

State/Prov

Zip / Postal Code

Complete Your Order:

By Fax:

By Mail:

Ear Gear

BY E-mail:

Fax this completed

form (with Credit
Card info) to:

Mail this completed

form (with Credit
Card info, or cheque
or money order) to:

11651 McGowan Rd.

Lake Country B.C.
Canada V4V 1J2

Print and scan this form once complete,

E-mail it directly to us.
Ear Gear:
info@gearforears.com

1-250-766-9099

OR

* If sending money order from U.S., please use international money order.
* Make Cheques and Money Orders out to: Ear Gear

OR

* Please note these custom models are non refundable,

except in the case of manufacturing defect