Print this form and use for phone, fax, or mail orders.

elton Optics - Order Form
For ordering regular sunglasses

Name:______________________________________________________ Date:_____________

Mailing Address, Street:__________________________________________________________

City:________________________________ State: __________Zip:_______________________

Telephone:(______)________________________

Circle your choice of payment:

MasterCard

Visa

Discover

Am. Exp.

Money Order

Check

Credit Card No: ________________________________________________Exp. Date:_______ ; CVV(3 security code)_____ American Express(4 code)_______

Name on Credit Card: (If other than above):__________________________________________

Billing Address on Card (If other than above):_________________________________________

Type of Sunglass Ordered

Quantity	Style: Waterman, Voyager, Aviator, Navigator, Classic, Wraptors,or “FX” For the “FX” only: Saltwater, Bass or Trout Fishing Book	Lens Color Grey, Bronze, Eagle, DriveWear	Price




Nevada residents add 7.75% sales tax:
Add $8.00 Shipping and Handling:
Total:

To Order Is Simple, Just Call Our Toll Free Number:
1-800-634-6786/ (702) 895-7340

Or, Fax This Form To:
FAX: 1-702-895-6976/ (800) 677-1892

Or, Print This Form, Complete, and Send To:
elton Optical
3175 W. Ali Baba Ln. #803
Las Vegas, NV 89118