OvaTel.Com Fax Form
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Enter in all fields and fax to (702) 233-2602

Please note the following:We can only ship to the billing address:Prices are US Dollars only

First and Last Name:_____________________________________________________________

Billing address:__________________________________________________________________

City, State, Zip:_________________________________________________________________

Country: ______________________________________________________________________

Phone:________________________________________________________________________

Email:_________________________________________________________________________

Card Type: Visa - MasterCard (CIRCLE ONE)

Card Number: __________________________________________________________________

Card Expiration: ________________________________________________________________

Shipping charges are as follows:
Free USPS first class shipping - US only - (3 to 5 business day delivery)
USPS Priority Mail - USA including Alaska & Hawaii: $5.95 US dollars (2 to 3 day delivery)
 Canada: $6.95 US dollars
International Shipping: $8.00 (First class international mail)

OvaTel Per Unit Cost: $23.95 US DOLLARS ONLY

Number
Of
Units

       Price 
      US $

Shipping Price: US$
Total Price: US $
  US$ US$ US$
Total: US$ ____________
I agree to pay the above purchase to Fertility Tech Inc/Ovatel.
Please sign and date:

X____________________________________ / Date: _____________________________

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