SimulEyes®
Order Form

Picture

Your Special Offer Code is: SIM1-J46

Fax:
916-939-1010

 Mail:
 StereoGraphics
 P.O. Box 62900
 Eldorado Hills, CA 95762
 USA

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Name

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Address

City, State, Postal Code

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Country

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Phone

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Fax

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E-mail

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____________________________ Exp. Date _________

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Name as it appears on card

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Signature

Regular Price

You Pay

Quantity

Total

$119

$89

x _____

$ ______

Shipping and Handling: U.S. $8.00, Canada $12.50
   (International orders please fax 916-939-1010 for quote)


$ ______

Tax: California residents only, add 7.25% ($6.45 per unit)

$ ______

TOTAL:

$ ______