IAO Video Library Rental Form

Video Library Rental Form
Video Rental is only available to IAO Members in the USA or Canada. Rental fees include shipping costs to locations in the USA and Canada via UPS Ground. Borrowers must pay for and are responsible for returning the tapes/DVDs. Tapes/DVDs are rented for two weeks from the time of arrival. Tapes/DVDs not returned on time are subject to a $15 per week penalty. Tapes/DVDs not returned will be billed at the retail sale value. If a tape/DVD you request is on loan, we will waitlist your order and notify you of such.
Name:
IAO ID #:
Address Line 1:
Address Line 2:
City:
State/ Province:
Zip/ Postal Code:
Country:

Rental Code 1:	Video Rental Cost:
Rental Code 2:	Video Rental Cost:
Rental Code 3:	Video Rental Cost:
Total Due:	US $
Credit Card:	Visa MasterCard Discover American Express
Card Number:	Expires: Security Code:
Signature:

International Association for Orthodontics (IAO)
750 N Lincoln Memorial Dr., #422
Milwaukee, WI 53202 U.S.A.
+414.272.2757 ● Fax: +414.272.2754 ● WorldHeadquarters@iaortho.org