Mail or Fax in your order Print out the following order form and either Fax it to: (866) 211-0893 Mail it to: envisionTEK, Inc. 4300 Pine Creek Edmond, OK 73034
Product Information
Product:	_________________________________________________ Quantity: ___________
Product:	_________________________________________________ Quantity: ___________
Product:	_________________________________________________ Quantity: ___________
Billing Information
Name:	__________________________________________
Company:	__________________________________________
Address:	________________________________________________________
	________________________________________________________
City:	_____________________________
State:	_____________________________ Zipcode: ___________
Country:	_____________________________
Phone Number:	_____________________________
Shipping Information
Name:	__________________________________________
Company:	__________________________________________
Address:	________________________________________________________
	________________________________________________________
City:	_____________________________
State:	_____________________________ Zipcode: ___________
Country:	_____________________________
Payment Information
Payment Method: (check one)	Visa MasterCard Discover Card American Express
Cardholder Name:	__________________________________________
Card Number:	___________________________
Expiration Date:	_______________
Signature:	__________________________________________