Order Form to submit via mail/fax to:
Software works great on Windows 98 through XP operating systems.
NOTE: Software will not run on Vista or Windows 7.
PBSI
856 Johnson Street
Red Bluff, CA 96080
Or Fax to: 530-527-1778
Please allow 2-3 weeks for shipping.
Items Ordered: Enter the quantity of the item(s) you wish to order. Standard shipping and handling included. If special shipping & handling is requested, call or fax for additonal shipping fees.
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Item Number
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Items Included
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Quantity
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Price Ea.
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PBSI Station A
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Software; Reversible Occluder Glasses; Table Top Chin Rest
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$565.00
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PBSI Station
B
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Software: Reversible Occluder Glasses; Clamp on Table Top Chin Rest
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$589.00
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PBSI Station
C
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Software; Reversible Occluder Glasses; Hvy Duty Chin Rest
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$759.00
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Software Upgrade Only
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*Must have purchased previous software version
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*With retrun of parallel port dongle
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*Full price ($360)without return
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* $106.00
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A Chin Rest
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HCRTMR Table Model with 6" Base
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$179.50
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B Chin Rest
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HCRD2R Double Screw Clamp
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$218.80
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4523C Reversible Metal Frame Occluding Glasses
4856R Optokinetic Flag
2 OPK Flags
XXLOPK
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Revervisble Occluders
3" x 27" OPK Flag
(2) 3" x 27" OPK Flags
8"x36" OPK Flag
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$25.50
$26.00
$52.00
$41.00
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4677R Heavy Duty Chin Rest for mounting to desk (screws on table)
4629R Heavy Duty Chin Rest with Clamps (clamps to table)
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$360.00
$388.00
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*(Fax Order to Confirm International Fees)
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*+
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*Federal Express 1-day or 2nd Day S + H (if desired) Fax to confirm shipping fees
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*+
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Total
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For more items, please print and include a second form.
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Customer Information
*First Name ________________________
*Last Name ________________________
Company ________________________
*Email ________________________
Phone _________________________
Credit Card Information
*Card Type ________________________
*Cardholder’s Name As Shown On Card ___________________________________
*Card Number ______________________
*Expiration Date (mmyy) ____ / ____
*3 Digit Security Code _______________
*Required fields.
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Billing Address
*Address Line 1 ______________________
*City _______________________________
*State/Province _______________________
*Country _____________________________
*Zip/Postal Code ______________________
Shipping Address (if different from billing address)
Ship To Name __________________________
Address Line 1 __________________________
City __________________________________
State/Province __________________________
Country _______________________________
Zip/Postal Code _________________________
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Thank you for ordering from Alpha-PhoenixLLC. If you have any questions, please do not hesitate to contact us by phone at: 530-949-1353, or by email at: askdrcox@sbcglobal.net.
