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Video Surgeon 3 Mail Order Form
Your Order Information:
Name and Address:
(required) Name:
(required) Email Address:
Address:
Address 2:
City:
State:
Zip/Postal Code:
Country:
Remittance Information:
Please send your remittance (check, bank check, money order, etc.) payable to TMJ Software, in U.S.
Dollars to:
TMJ Software
Video Surgeon
4620 Derby Lane
Doylestown PA 18902
Personal checks may take 3-5 business days to clear. Certified forms of payment will be processed the
same day they are received. Please send a copy of this form along with your payment.
Upon the clearing of your payment, we will immediately send you an email notification with a download
link. If you ordered a CD, it will be shipped within a few days of payment clearance.