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Direct Sales Order Form

  • Direct Sales Order Form

  • MM slash DD slash YYYY

  • Eyecon with Penicillin, Sulfa and Hazard Platters

  • Price: $7,999.00
  • Price: $11,340.00

  • Notification and Access of Maintenance Update Files

  • Periodic drug database maintenance is required to assure your Eyecon is current with the latest drug information.

  • I Acknowledge the Eyecon Software License Agreement Includes:

    • The MEDI-SPAN drug database is licensed, third party owned and may not be duplicated, sold, or removed from the Eyecon.
    • Upon purchase, the Eyecon will be registered on the Eyecon website - EyeconVPC.com
    • The Eyecon must be kept up-to-date with the latest MEDI-SPAN drug database.
    • All Eyecon units include an initial 12 months MEDI-SPAN subscription, thereafter, charged at $279.00 annual fee to maintain access to the updates.
    • I have the ability to receive update notifications via email.
    • I am authorized by my company to accept the maintenance terms above.

  • Confidential Customer Information

  • By completing the following information and signing this document, the undersigned agrees to the license terms as set forth in the Eyecon Software Product License Agreement.

  • Sold to:

  • Ship to:

  • MM slash DD slash YYYY
  • An order acknowledgement will be emailed or faxed when the order is processed. The projected date of shipment will be included with the order acknowledgement. Prepayment by check or credit card will be requested when shipment is ready.