Evdara Optical Instruments
Evdara Optical Instruments Company Profile of Evdara Contact Us


 

ORDER FORM

DATE:
Day:
Month:
Year:
Full Name:
Business Name (if applicable):
Business Phone:Area CodeTel:
Business fax: Area CodeTel:
Cell Phone:Area Code Tel:
Email:
Invoice Address:

Delivery Address:

 
Part Number
Short Description
Number of UNITS ordered
Cost per unit
Total
1
 
 
 
 
 
2
 
 
 
 
 
3
 
 
 
 
 
4     
5     
6
 
 
 
 
 
Extra Delivery and Installation costs as quoted
GRAND TOTAL
R

Please be aware that additional delivery and installation costs will be incurred outside of the Johannesburg area. Evdara Institute will not be held liable for delays should any of the information submitted here be incorrect or incomplete for whatever reason. The terms and conditions of the quote and sale are detailed below.

I, the undersigned, hereby place the order as detailed. I hereby bind myself by all of Evdara's conditions and terms of sale.

Signature: ________________________________________