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Plastic/ENT Surgical Instrumentation - Sontec Instruments

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14.5<br />

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

®<br />

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

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 />

International Orders<br />

Payment and Shipping Info<br />

Credit Card Billing Address Payment Options<br />

Company / Practice Name / Name<br />

Street Address<br />

Street Address<br />

City State Postal Code<br />

Country<br />

Please check one:<br />

o UPS International<br />

o UPS Canada Ground (2-5 days)<br />

o Fed Ex International<br />

Email / Fax<br />

Name on Card<br />

Exp Date Signature (REQUIRED)<br />

Security Code<br />

Please check one:<br />

o Visa o Mastercard o American Express<br />

o Wire Transfer<br />

Shipping Options Ship To/Delivery<br />

• We cannot guarantee postal shipments.<br />

Use at your request, no refunds.<br />

Signature Date<br />

<strong>Sontec</strong> Wire Transfer Information<br />

Contact us for banking by wire information<br />

Company / Practice Name<br />

Attn:<br />

Street Address<br />

City State Postal Code<br />

Country<br />

*( )<br />

Telephone Number/Delivery<br />

Purchase Order Number<br />

Fax / Email<br />

orderform may_08

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