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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