NOMAD™ Rapid Order Form

You may print this page, complete and fax to 858-675-9380. We will extend Net 10 day payment terms and bill you. For your convenience, we accept Visa or MasterCard and will contact you to receive credit card information. You may also print this page, enclose a check and mail to:

Blue Lion's Choice
12225 World Trade Drive – Suite H
San Diego , CA 92128

Name:

Street:
City:
ST:
ZIP:
Telephone:
Fax:
Email:
Method of Payment: Credit Card Check Enclosed
   
I am ordering NOMAD™ Portable X-Ray Device(s) @ $6,848.00 each = $
I am ordering NOMAD™ Hard Case(s) @ $465.00 each = $
Sub Total = $
% Sales Tax = $
TOTAL = $
Terms & Conditions. Copyright ©2006 Blue Lion's Choice