ORDER FORM
(Please print this form and either mail or fax it to us)
VIDEOTAPES
............
$20.00 Each
QUANTITY
TOTAL
GS-1
What is Glaucoma? What is Not!
GS-2
Glaucoma Types and Testing Procedures for all Glaucomas
GS-3
Glaucoma Treatment/Medications & Their Side Effects
GS-4
Laser and Surgery for Glaucoma
GS-5
Cataract Surgery for the Glaucoma Patient
Special Offer - All 5 tapes $80.00
(set)
AUDIOTAPES
............
$15.00 Each
QUANTITY
TOTAL
GS-1
What is Glaucoma? What is Not!
GS-2
Glaucoma Types and Testing Procedures for all Glaucomas
GS-3
Glaucoma Treatment/Medications & Their Side Effects
GS-4
Laser and Surgery for Glaucoma
GS-5
Cataract Surgery for the Glaucoma Patient
Special Offer - All 5 tapes $60.00
(set)
Sub-Total
7% Sales Tax (FL Res.)
Shipping & Handling $7.50 on orders up to $60.00
Shipping & Handling $10.00 on orders over $60.00
Overnight Surcharge $10.00 (Credit Card Orders)
TOTAL:
Method of Payment: [
..
] Check Enclosed (Order held 10 days on checks)
Credit Card Mastercard or Visa only (Circle One)
Name
Card #
Exp.Date
Signature
.
MAIL TO:
Audio/Videotape Sales
The Gulf Coast Glaucoma Clinic
3920 Bee Ridge Road,
Building F, Suite B
Sarasota, FL 34233
FAX TO:
(941) 925-4751
.
SHIP TAPES TO:
(please include: name, address, zip code and phone )
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