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Plastic/ENT Surgical Instrumentation - Sontec Instruments

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7248 South Tucson Way • Centennial, CO 80112 USA •<br />

toll-free: (800) 821-7496 • local: (303) 790-9411 • fax: (303) 792-2606<br />

e-mail: sales@sontecinstruments.com<br />

Domestic Orders<br />

Billing and Shipping Info<br />

Billing Address Or Credit Card Billing Address Payment Options<br />

Company / Practice Name<br />

Street Address<br />

City State Zip<br />

( )<br />

Telephone Number<br />

Please check one:<br />

o UPS Ground<br />

o UPS 2nd Day<br />

o UPS 3rd Day<br />

o UPS Overnight<br />

o UPS Overnight early a.m.<br />

o Fed Ex Ground<br />

o Fed Ex Standard Overnight<br />

o Fed Ex Priority Overnight<br />

o USPS Priority Mail<br />

o Other, please specify:<br />

( )<br />

Fax Number<br />

Name on Card<br />

Please check one:<br />

Shipping Options Ship To/Delivery<br />

<strong>Sontec</strong><br />

®<br />

<strong>Instruments</strong><br />

Exp. Date Signature (REQUIRED EACH TRANSACTION )<br />

Security Code<br />

o Visa o Mastercard o American Express<br />

Company / Practice Name<br />

Attn.:<br />

Street Address<br />

o Check / Money Order<br />

City State Zip<br />

*( )<br />

Telephone Number<br />

Purchase Order Number<br />

Is above a residence?<br />

o Yes o No<br />

Please Note: We ship to P.O. Boxes by Express Mail ONLY.<br />

For International billing please see next page<br />

14.4

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