Eye Surgery Rental Extension

Package *

-- Please Select --3-Piece Sleep System Add Day +$25.003-Piece Sleep System Add 4-7 Days +$65.00Desktop Portal Add Day +$25.00Desktop Portal Add 4-7 Days +$40.00Seated Support Chair Add Day +$45.00Seated Support Chair Add 4-7 Days +$99.00Economy Package Add Day +$35.00Economy Package Add 3 Days +$50.00Economy Package Add 4-7 Days +$95.00Basic Package Add Day +$40.00Basic Package Add 4-7 Days +$125.00Comfort Package Add Day +$45.00Comfort Package Add 4-7 Days +$130.00Mattress Slide-in Add 4-7 Days +$40.00Mattress Slide-in Add Day +$25.00Vitrectomy Mirror Add Day +$10.00Vitrectomy Mirror Add 4-7 Days +$20.00Ultimate Package Add 4-7 Days +$200.00Ultimate Package Add 1 Day +$45.00Eye Surgery Part Add 1-7 Days +$20.00

First Day of New Period *

Customer Service Representative Helping with this Order (optional)

-- Please Select --None Allison John Milos

Notes (optional)

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