TRIAD PUBLISHING COMPANY
EYE CARE NOTES ORDER FORM

Print a copy, and mail or fax to Triad Publishing Co.
P.O. Box 13355, Gainesville, FL 32604
Fax: 1-800-854-4947
Email: orders@triadpublishing.com


PRICING

Practice:
$295 + $10 for each doctor in the practice (a 1-doctor practice would be $305; 2 docs, $315, etc.)
Institution: single location, multi-user, $550
Shipping & handling (per address): Continental U.S.: $8; Alaska, Hawaii, U.S. terr.: $14; Canada, $15.00. International: contact Triad for shipping costs; be sure to specify air or surface. Payment must be in U.S. funds drawn on a U.S. bank, world money order, or credit card (Visa, Mastercard, Discover, AmEx).


PLACE MY ORDER TODAY!

Practice: $.................... (or) Institution: $.................... Shipping and handling: $.................... 6% Sales tax (Florida orders): $....................

Total due: $...................

Method of payment:
................ Check enclosed (must be in U.S. funds drawn on a U.S. bank)
................ Institution purchase order (U.S. only)
................ Credit card (circle one):   Visa --- MC --- Discover --- AmEx


Card No. ............................................................................................................Exp. date..............................................

Cardholder's name:........................................................................................
Signature
:....................................................................................

SHIP TO:  Name:..............................................................................................................................................................................................................
Address:................................................................................................................................................................................................................................
City/State/Zip:......................................................................................................................................................................................................................
Phone..............................................................   Fax...................................................................  Email............................................................................
Contact person for correspondence (important!):.....................................................................................................................................................


LICENSE AGREEMENT

All material in Triad's Eye Care Notes is subject to and protected by U.S. copyright law. By your purchase, as licensee you are granted the limited right to reproduce topics to give to patients, for newsletters or brochures, or similar uses. Website or internet use is not included in this right. You may not remove or conceal the copyright notice. If you adapt the topics in any way, that is, if you make any changes, additions or deletions to the text, or translations into a language other than English, you assume full responsibility for any liability that may result because of the changes. All such changes are covered by the original copyright. You may not resell any part of the material covered by this Agreement. Any new topics, updates, different formats, or other products based on Triad's Eye Care Notes that you may receive or purchase in the future are covered by this Agreement. Please sign below to indicate that you have read the Agreement and agree to its terms.

Licensee: Print name ...........................................................................................................................................   Date ............................................
Signature ............................................................................................................................................................................................................................
If signing on behalf of a corp. or partnership, name of corp. or partnership: ..................................................................................................
........................................................................................................................................................................................................................................................

All sales final. Prices subject to change without notice. Copyright 1999-2010 Triad Communications, Inc.