An important message for our customers: Due to the unprecedented delays within the supply chain, rapid changes seen in both product and freight costs, the price reflected on this website may not be correct. We sincerely apologize for this, and in order to get the most up to date information on specific product availability and pricing, please contact Bill Kudzia @ 877-398-5558, or feel free to email him bkudzia@novavisioninc.com.

Credit Card Ordering Information

Email address: officemanager@novavisioninc.com

Fax: After entering the information, print out and fax to: 419-353-7908

I am requesting to use my credit/debit card for payment on all future orders for my account using the following information:

1. Name (exactly as shown on the card)

2. Card Type (VISA, MasterCard, etc)

3. Card Number: (NOTE: Since email is not secure, do not email the card number - instead phone or fax us the card number)

4. Expiration Date:

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

6. Mailing Address and Zip Code where billing statements are mailed:

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

NOTE: 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 product, please indicate here:

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

______ Yes, only ship product which requires a signature to accept the product

Your Name: _________________________________

Company Name: _____________________________

Office Telephone: ____________________________

Fax: _______________________________________

Mailing Address: _____________________________