Video Phone Order Form

Your name
eMail address
Phone

Billing Address (must be your exact credit card billing address):
Street
Apartment/Suite
City, State, and Zip-code
Country

Shipping Address (If different than Billing address. UPS cannot deliver to P.O. boxes):
Street 1
Street 2
City, State, and Zip-code
Country

Products ordered: (You may use the BACK button on your Web browser)

Model & Cost		Quantity		Total
	x		=
	x		=
	x		=
	x		=
		Subtotal	=
UPS Shipping/handling (7-10 business days) for TOTAL ORDER:*
Express Shipping (3-6 business days) add $10 for EACH item: Total Shipping:
For Iowa shipping addresses only, add 6% tax of Subtotal:
*Order Total:*
* For your convenience and simplicity, we are not longer charging shipping for each item, for orders placed after 9/15/99, in lieu of 2nd item discount. But we must still charge $10 for UPS EXPRESS shipping (3-6 business days) by item.

If paying by:

Check: (Click here for remittance address). Order will be shipped upon receipt of payment.

Credit Card

Credit Card: Card No:
Expiration Date (Mm/Yy): Name Appearing on Card:

Warning: This form does not presently use SSL encryption
You may call in your order at 800-DATA1-OK,
or print this form and fax it to 877-727-9070