Ordering Information

Send and Email With The Following Information:

To: jthilmony@novavisioninc.com

Subject: Re: Request for extended payment terms

Body of Email:

1. Credit Reference #1 (Name, City, State, Phone)
2. Credit Reference #2 (Name, City, State, Phone)
3. Credit Reference #3 (Name, City, State, Phone)
4. Products you wish to Purchase:
5. Projected Annual Purchases ($)
6. Maximum Credit Amount Requested:
7. Payment terms requested (net 10 days, net 15 days, etc):
8. I understand I must use a valid credit card to pay for my initial order at the time of shipment if the requested ship date is less than 30 days from the date this request if fully completed.
9. I understand my credit card will also be used to guarantee future payment. If timely payments are not made, I authorize NovaVision to make a charge to the credit card which will include a 5% additional fee for late payment and credit card processing costs. I agree to update credit card information as requested by NovaVision. See credit card information required below.
10. Please allow 30 days for us to collect, evaluate and approval of your credit information.
11. Please provide all of the information below:
    

CREDIT CARD INFORMATION REQUIRED TO GUARANTEE PAYMENT OF EXTENDED PAYMENT TERMS:

A. Name (exactly as shown on the card)

B. Card type (VISA, Master Card, etc)

C. Card Number: (NOTE: since email is not secure, do not send the card number by email — instead phone or fax us the card number.

D. Expiration date

E. Last 3 digits of the security code in the signature panel on back of card:

F. Mailing address and Zip code where statements are mailed

G. Credit Limit on this Credit Card:

H. Specify if a personal or business credit card:

I. The name and HOME phone number of the person authorizing the use of this card:

J. All orders processed by credit & debit card payments are shipped by means which do not require a signed authorization of material receipt. If you require signed authorization to accept the product, please indicate here:

______ No, I do not require signed authorization to accept product

______ Yes, only ship product by carriers which require a signature to accept the product

K. Your Name: _________________________________

L. Company Name: _____________________________

M. Office Telephone: ____________________________

N. Fax: _______________________________________

O. Mailing Address: _____________________________