Fax Order Form

Print and Fax/Mail to: 1-(813)342-7970                   

CE XRAY

Name:_______________________________________________________

Address:_____________________________________________________

City__________________     State_____________ Zip_________

Phone#:____________________   E-Mail:__________________________

Product:________________________Qty:_____=TOTAL_________

Product:________________________Qty:_____=TOTAL_________

Product:________________________Qty:_____=TOTAL_________

How did you hear about us?_______________________

*No Tax on Education Materials   ** Free Shipping inside the continetal U.S.

Mail Check or Money order to :
CE Xray
PO Box 5278
Sarasota, Fl 34277

We Accept VISA, MC, AE, AND DISCOVER

#______________________________    EXP: ________

 CCV#____________(3 or 4 digit on back AE on Front of card)  TOTAL $_________

Signature:_____________________________________________

 

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