FLUXX Audio CEP | TESTING Order ID This online order form is for Custom CEP Earmolds, Hearing Protection, and COMMS. Account# Step 1: Participant DetailsDateParticipant's Name*Group Name, or IDUpload a BULK Order [via Excel Spreadsheet]NoYesUpload PDF Order Form or Excel Spread Sheet. Drop files here or Select files Accepted file types: xlsx, zip, stl, pdf, Max. file size: 128 MB. Is this order part of a Group Shipment?NoYesGroup NameMicrosonic Account # (If applicable)I have an order update.NoYesOrder Update InformationAre you placing a remake or duplicate order?NoYesPrevious Order NumberDesignate REMAKE or DUPLICATE.Shipping RecipientName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone*Billing Contact InfoSame as shipping?* Yes No (add billing contact) Email PhoneName First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Step 2: Ear ImpressionsParticipants Name*Ear Impressions*My ear scans have already been submittedI'm uploading digital ear scansI'm mailing physical impressionsUse scans from previous orderPrevious Order NumberUpload Files Drop files here or Select files Accepted file types: stl, asc, Max. file size: 128 MB. Microsonic Inc. ATTN: Jim DiSpirito 2960 Duss Ave. Ambridge, PA 15003 Please include a copy of this order form with your ear impressions. Step 3: CEPs, Hearing ProtectionCustom ProductsView our Hearing Protection Catalog HERE. CEP - Custom Communication Earplugs Passguard™ Earplugs Sound Defenders™ Earplugs Communication Earpieces (Passguard™) Communication Earpieces (M2000™) PULSE™ (M2000) [NRR25] Made with our M2000 silicone, these sleep plugs are amazingly comfortable and provide fantastic attenuation ... and better sleep! Our M2000/M35 silicone provides slightly more occlusion and is slightly softer than our Passguard™ silicone material ... but provides great protection at NRR26. M2000 communication earpiece has the ability to be clear. Whether for communication devices or hearing protection, Microsonic uses only the highest quality materials to ensure maximum fidelity and comfort. The compact tubing stretches and recoils as needed. For use with communication earmolds. Extends up to 16" FEATURES: • Custom Fit Earmolds | Coiled Sound Tube | Gator Clip | Clear or Black Tubing | Hypoallergenic Materials | 6 Month Standard Warranty Passguard communication earpiece. Whether for communication devices or hearing protection, Microsonic uses only the highest quality materials to ensure maximum fidelity and comfort. The compact tubing stretches and recoils as needed. For use with communication earmolds. Extends up to 16" FEATURES: • Custom Fit Earmolds | Coiled Sound Tube | Gator Clip | Clear or Black Tubing | Hypoallergenic Materials | 6 Month Standard Warranty Passguard™ is best known for it's high attenuation [NRR27], with hear-through characteristics. This makes Passguard earplugs the first choice in industrial/safety situations when hearing commends, signals, or alters is vital.Select a Color Style - SoundDefenders (M2000/M35)PLUS $3/per mold Color Charge for: Swirl, Gel-e-burst, & Polka-dots Solid | Pick 1 color Swirl | Pick 2 to 3 colors Marble | White + 1 color Gel-e-burst | Clear + 3 colors Polka-Dots | 1 main color + 3 colors Select a Color Style - PULSE™ (M2000/M35)PLUS $3/per mold Color Charge for: Swirl & Gel-e-burst Solid | Pick 1 color Swirl | Pick 2 to 3 colors Marble | White + 1 color Gel-e-burst | Clear + 3 colors PULSE™ earplugs are filtered hearing protection made from our M2000 silicone. Super comfortable 1/2 shell design, perfect for music or hearing conversations. FEATURES: Available with 10, 15, 25, or 30dB filters. PLUS $3/per-mold Color Charge for: Swirl, Gel-e-burst, & Polka-dots PLUS $3/per mold Color Charge for Swirl Select a Color Style - Passguard™PLUS $3/per-mold Color Charge for Swirl Solid | Pick 1 color Swirl | Pick 2 to 3 color Marble | Pick White + 1 color Earmold Style*Select1/2 Shell3/4 ShellFUll ShellColorsPlease select colors below. You can see a chart or our M2000 Translucent colors HERE. Clear Beige White Black Brown Red Orange Green Yellow Blue Blue Tint Tnt (Rose) Turquoise Pink Iced Tea Purple INVISIEAR Fluxx Green ColorsPlease select colors below. You can see a chart or our Passguard™ Opaque colors HERE. Beige White Black Brown Red Orange Green Yellow Blue Turquoise Pink Iced Tea Purple Fluxx Green Removable Cord [Lanyard)SelectPlastic Removable Cord [Free)Fabric Removable Cord [+ $6.00)Finish*GlossyMatteMarkingsR/L & InitialsR/L + NicknameGlitterNoMulti-ColorCrystalSilverGoldOrangePinkBlackGreenBluePurple(+ $3/mold)Filters10dB15dB25dB30dB (Solid)Extra Filters10dB15dB25dB30dBNumber of PAIRS or filtersSpecial Instructions for PULSE™ Step 4: CEP ConfigurationCEP Model*CEP508-C15CEP508-C16CEP505-C11CEP505-C11-VRoanwell - Tanager CEPOTHERDepending on the model# of your device: We may request to borrow your CEP for measurement purposes. Other CEP ModelQuantity (Pairs)Please enter a number greater than or equal to 1.Earmold Style*Select1/2 Shell3/4 ShellFull ShellVentingNo (Default)Yes (Pressure Vent)Step 5: For Solid Colors Only (CEPs)M2000/M35 Silicone only. Select from translucent colors.View color options here.LEFT Ear • Solid ColorFor ordering different SOLID COLORS for each ear.ClearBeigeBlackRedOrangeWhiteGreenYellowBlueBlue TintTint (Rose)TurquoisePinkIced teaPurpleBrownINVISIEARFLUXX GreenRIGHT Ear • Solid ColorFor ordering different SOLID COLORS for each ear.ClearBeigeBlackRedOrangeWhiteGreenYellowBlueBlue TintTint (Rose)TurquoisePinkIced teaPurpleBrownINVISIEARFLUXX GreenMarkingsR/L & InitialsR/L + NicknameFinishing*Glossy FinishMatte FinishNicknameMAX 8 characters.GlitterNoMulti-ColorCrystalSilverGoldOrangePinkBlackGreenBluePurple(+ $3/mold)This field is hidden when viewing the formQuantity (Pairs)Please enter a number greater than or equal to 1. Do you have any supporting documents?NoYesUpload Supporting Documents Drop files here or Select files Accepted file types: txt, xlsx, csv, doc, docx, stl, acs, jpg, jpeg, png, pdf, Max. file size: 128 MB. Special Instructions * For Official Use OnlyShipping MethodUPS 2nd Day - $17 {all_fields}
