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SimulEyes® Order Form |
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Your Special Offer Code is: SIM1-J46 |
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Fax: 916-939-1010 |
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Mail: StereoGraphics P.O. Box 62900 Eldorado Hills, CA 95762 USA |
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______________________________________________ |
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Name |
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______________________________________________ |
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Address |
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City, State, Postal Code |
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______________________________________________ |
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Country |
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______________________________________________ |
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Phone |
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______________________________________________ |
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Fax |
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______________________________________________ |
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E-mail |
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Visa or Mastercard number (circle one) |
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____________________________ Exp. Date _________ |
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______________________________________________ |
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Name as it appears on card |
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______________________________________________ |
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Signature |
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Regular Price |
You Pay |
Quantity |
Total |
$119 |
$89 |
x _____ |
$ ______ |
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Shipping and Handling: U.S. $8.00, Canada $12.50 (International orders please fax 916-939-1010 for quote) |
$ ______
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Tax: California residents only, add 7.25% ($6.45 per unit) |
$ ______ |
TOTAL: |
$ ______ |
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