Mail Order Form

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Name_______________________________
Company____________________________
Street______________________Suite_____
City______________ State______Zip______
Country _____________________________
Phone_____________ FAX______________
Email________________________________

 

Please see Models & Prices to select equipment

Equipment Ordered:
 [   ]   ZACC   $1795 [   ]   COLOR-EYE   $395
 [   ]   ZACC-BW   $1495  [   ]   GOLDEN-EYE   $295
 [   ]   FLEX-EYE   $1495  

Payment Amount: US$_______
(CA residents only: add 7.75% sales tax

Payment Method:
[   ]   Master     [   ] Visa     [   ] AmEx     [   ] Check

 

Credit Card Information:

Name on Card__________________________
Card Number___________________________
Expiration Date________ Card Type________

Checks payable to:

  OVAC, Inc.
67-555 E. Palm Canyon Dr.
Unit C-103
Cathedral City, CA 92234
800-325-4488
FAX 760-321-9711
vision-aide@ovac.com