FogBlocker Order Form

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FogBlocker Order Form

Exclusive Ordering Option for I Care Co-op Members

The ICC will tabulate and forward your order to Bright Optical on your behalf.

Details: $5.50 per dry cloth (500 uses); $3.75 per 20 wet wipes

Order 30 or more and receive Free Shipping
Order 50 or more and receive a free point of purchase display unit

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ICC Member Name *

Your answer

Practice Name *

Your answer

Mailing Address - (where product should be sent) *

Your answer

City *

Your answer

State *

Your answer

Zip Code *

Your answer

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