USAscopes
210 E. Park Ave -/- Pharr, TX 78577 956-783-2148 -/- Fax 783-1810 -/- JCadena@aol.com
Please fill out and fax or e-mail ( Porfavor llenar los datos e enviar por fax or correo electronico )
Doctor / Institution ____________________________________________________________________
* Contact Person _____________________________________________________________________
* Address ___________________________________________________________________________
* City _____________________________________ Sate ____________________ Zip ______________
* Telephone (______) __________________________________________________________________
Fax (______) _________________________________________________________________________
Payment: Total Enclosed $ _______________ Check Money Order Wire Transfer
Charge Amount $ _______________ Master Card VISA American Express Discover
* Credit Card No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ * Expiration Date _________ / _____
* Three numbers on the back of the Credit Card _ _ _ or four on front of Amex _ _ _ _
* Address ________________________________________________________________________
(Address where credit card statement is mailed if different from above)
* Authorized Signature ______________________________________________________________
SHIPPING ADDRESS IF DIFFERENT FROM THE ABOVE ADDRESS
ATTENTION
STREET
CITY / STATE / ZIP
PHONE / FAX / E-MAIL
(Credit Card purchases will appear on your statement as charged by Muisano USA, Inc.)
(Fields with an * must be filled out or we will not be able to process the credit card)
All our products have a 30 day money back guarantee. Refunds or Returns must adhere to company policy.
WIRE TRANSFERS:
Capital One 300 S. Cage -/- Pharr, TX 78577 -/- 956-787-1517 -/- Routing # 111901014 -/- Swift Code # HBK144US
USAscopes 210 E. Park Ave. -/- Pharr, TX 78577 -/- 956-783-2148 -/- Acct.# 3820020226
Prices and Modifications subject to change without previous notice - Warranties must adhere to company policy