All Ultras are not created equal. You've probably heard talk about poor 2D image quality on nVIDIA's in general at high resolutions, especially on Trinitron monitors... well, some cards are worse than others.
I'd definitely recommend going with Visiontek (they manufacturer ELSA cards too)...they use the best components on their boards and have the best image quality in 2D. A couple of my friends have or had Visiontek ultras. Whatever you do...try to get a card that was recently manufactured...not one that has been on the shelf for a couple months. The yields on the memmory is better for the more recently manufactured cards and, thus, your card should overclock better.
And don't worry about the heatsink and cooling fan, only the RAM sinks. If your going to OC your chip at all you should replace the heatsink with a copper heatsink fan combo of your own and use some Artic Silver thermal epoxy to attach the sink. Just my opinion...