Order Form

Order
Please note, $25.00 (US) order minimum per order.

Qty Part Number Description
Please use our part numbers when ordering.


Contact Information
Your Name:
Company:
Daytime Phone:
Fax:
Email:
Repeat Email:
  Please type your email address a second time and check to make sure both are correct.
You will receive a confirmation via email including prices and scheduled ship date.

Billing

Billing name, address and zip must match the address the credit card is billed to.
Credit Card Type: Visa

MasterCard

 American Express
Name:

Street:

City:

State: Zip:

Card #:

Expiration: / (Month/Year)
3 Digit Security Code:

 

 (Note: this is a 3 digit security number on the rear of the card just after the card number or the last four digits of the card number.
Customer Service Phone Number on Credit Card

(Note: This number is also on the back of the card)

Shipping

The shipping address MUST be registered with the credit card company as a valid ship to address for the above card or this order will not ship.
Same as billing address:
Name:
Street:
Address (cont.):
City: State: Zip:
Method: UPS Ground UPS 3 day select
UPS 2nd day air UPS Next day air
How did you find us

Terms
Prices and specifications subject to change without notice. 
No returns without prior approval.  All returns must have an RMA number.
Shipping is FOB Boyertown, PA, USA
Material returns will have a 15% restocking charge when returned to accommodate the customer. No returns after 30 days.

 

 

You may also fax your order to the sales department at (610) 754-9766.

This order form page uses a secure server

© 1995-2005 MicroImage Video Systems, a division of World Video Sales Co., Inc.
All rights reserved.  Specifications subject to change without notice. 11/07/08
Problems with this site? Contact the  webmaster  
w w w .  m i v s . c o m