Return to the Audex Home Page...HomeContact UsFind Us

Products About Audex News Hearing Study Sign Guestbook Free Rewards Questionnaire Investor Relations



  ID Reward Card Program  
     
First Name:
Last Name:
Company:
Mailing Address:

City:

State:(if in US):
Country:

Postal Zip:

Home Phone (with area code):
Work Phone:
E-mail Address:
   
   
Number of Cards Requested:
Brand of Hearing Aid:
Do your hearing aids have t-coils?
Where are your t-coils?
   
   
Name of Audiologist or Dispenser:
Phone:
Mailing Address:
City:
State:
Country:
Postal Zip:
E-mail Address:
   
   
Name of Relative or Friend:
Phone:
Mailing Address:
City:

State:

Country:
Postal Zip:
E-mail Address:
   
 
I understand that the Audex® I.D. Reward Card and Audex® Loyalty I.D. Card are not credit cards and cannot be used for purchasing products or services. I understand their purpose is to identify me and serve as security when I borrow Audex® receivers at public facilities. Furthermore, I understand that there cards may provide me with discounts and free long distance time as specified by hearing aid dispensers and other merchants participating in the Audex® I. D. Reward Card Program. I agree to return any Audex® receivers loaned to me by any facility where these cards are used as security and identification. If I fail to return the receiver, I agree to ship it to Audex®, as soon as I am notified, postage paid. If I fail to mail the receiver to Audex® within seven days of notification, I agree to pay the standard retail price less 20% to Audex® upon receipt of an invoice. This program is free to the user, and may be modified or cancelled without notice at the discretion of Audex® and the participating businesses. The I.D. Reward Card and Loyalty I.D. Card remain the property of Audex®. Misuse, abuse, or other improper application of these cards may, at Audex®'s discretion, result in their cancellation. Audex® reserves the right to restrict the scope and issuance of cards through this program at its sole discretion. Cards expire 180 days after first use, or 180 days after last addition of free minutes. This program is restricted to persons with hearing impairment, and those professionals providing hearing accessibility.

I agree with the conditions:

   

Back to Home Page 


ProductsAbout AudexNewsHearing StudySign GuestbookFree RewardsQuestionnaireInvestor Relations
HomeContact UsFind Us

Copyright © 2002, Audex Assistive Listening Systems