ODs on Finance Order (Imaging) iCare CUSTOMER STATUS(Required) New iCare Customer Existing iCare Customer iCare ACCOUNT NUMBER DATE(Required) MM slash DD slash YYYY COMPANY NAME(Required) COMPANY PHONESHIPPING CONTACT(Required) First Last SHIPPING EMAIL(Required) SHIP TO(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Is the BILL TO address different than the SHIP TO address? Yes BILLING CONTACT IF DIFFERENT First Last BILLING EMAIL IF DIFFERENT BILL TO Street Address Address Line 2 City State / Province / Region ZIP / Postal Code RETINAL IMAGING & PERIMETRYiCare DRSplus Quantity Price: $21,900.00 Quantity MSRP: 25,995.00 1-Year Warranty Shipping $460 per device Table not included KEY FEATURES • Fast, easy and fully automated operation • 2.5 mm minimum pupil size • TrueColor Confocal Technology iCare EIDON UWFL Quantity Price: $44,300.00 Quantity MSRP: 55,895.00 1-Year Warranty Shipping $630 per device Table not included KEY FEATURES • Confocal Ultra-Widefield, up to 200 degrees • Quality Images through cataract and media opacities • Multiple imaging modalities including TrueColor, Infrared and RGB channels iCare EIDON AF UWFL Quantity Price: $48,300.00 Quantity MSRP: 60,895.00 1-Year Warranty Shipping $630 per device Table not included KEY FEATURES • Confocal Ultra-Widefield, up to 200 degrees • TrueColor, Fundus Autofluorescence, Infrared and RGB channels • Easy to use, speeds up patient workflow iCare EIDON FA UWFL Quantity Price: $59,900.00 Quantity MSRP: 79,900.00 1-Year Warranty Shipping $630 per device Table not included KEY FEATURES • Includes features and functionalities of EIDON technology, up to 200 degrees • High resolution fluorescein angiography images • Fully automatic, easy to use and requires minimal staff trainingiCare COMPASS (ask your local rep for special financing or trade in options) Quantity Price: $38,300.00 Quantity MSRP: 44,400.00 1-Year Warranty Shipping $585 per device Table not included KEY FEATURES • Standard perimeter with Auto-focus — no trial lens needed • Active retinal tracking compensating for poor patient fixation in real-time • High-resolution confocal TrueColor imaging of the retina I understand applicable taxes will be added once order is processed.(Required) Yes I understand a shipping charge will be applied for each device once order is processed.(Required) Yes FINANCING OPTIONS(Required) I am using my own financing company. Please provide an itemized invoice. Contact me with your financing options. I am paying cash. TOTAL (does not include shipping, tax or trade-in) CREDIT CARD NUMBER - TO HOLD ORDER(Required) EXPIRATION MONTH(Required) EXPIRATION YEAR(Required) CVV CODE(Required) SIGNATURE(Required) Reset signature Signature locked. Reset to sign again DATE(Required) MM slash DD slash YYYY FOR 2022 TAX PURPOSES ALL ORDERS MUST BE RECEIVED BY DECEMBER 10, 2023. Once your order is processed devices should ship in 5-7 business days. This ODs on Finance special pricing expires on December 30, 2023.
