Computerized Physiologic Blind Spot Mapping
The Next Generation . . .
Free *Bonus Blind Spot Mapping System - (See "Free Blind Spot" Box Right Below)
Printable Order Form

 

Order Form to submit via mail/fax to

NOTE:  Software works great on Windows 98 through XP operating systems. Requires PRO Version of newer operating systems.


     

 
 

Blind Spot Mappping

1310 Forbes Drive

Orland, Ca 95963

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.

 

Item Number

Items Included

 

 

 

Quantity

Price E

PBSI Station A

Software;  Reversible Occluder Glasses; Table Top Chin Rest

 

 

 

 $584.00

   PBSI Station  B

Software:  Reversible Occluder Glasses; Clamp on Table Top Chin Rest

 

 

 

 $608.00

PBSI Station C

Software; Reversible Occluder Glasses; Hvy Duty Chin Rest

 

 

 

 $788.00

Software Upgrade Only

 

 

*Must have purchased previous software version

 

*With retrun of parallel port dongle

*Full price ($360)without return

 

* $106.00

 

 

 

 A Chin Rest

HCRTMR Table Model with 6" Base  

 

 

 

 $198.00

 B Chin Rest

 HCRD2R Double Screw Clamp

 

 

 

 $238.00

4523C Reversible Metal Frame Occluding Glasses 

Optokinetic Flags:

SMOPK

SMOPK2

XXLOPK

Combo OPK

XXLOPK2

 

Revervisble Occluders

 

 

 

 

4" x 36" OPK Flag

 

(2) 4" x 36" OPK Flags

 

8"x36" OPK Flag

(1) 4"x36" + (1) 8"x36" Flag

(2) 8" x 36" OPK Flags

 

 

 

 

 

 

 

 

 

 $26.50

 

 

 

 

   $31.00

 

   $60.00

 

   $42.00

  

    $68.00

   

   $77.00

 

 

4677R Heavy Duty Chin Rest for mounting to desk (screws on table)  

4629R Heavy Duty Chin Rest with Clamps (clamps to table)               

 

 $369.00

 $397.00

*(Fax Order to Confirm International Fees)

 

 

 

*+ 

 

 

 

 *Federal Express  1-day or 2nd Day S + H (if desired) Fax to confirm shipping fees

*+ 

 

Total

 

 

For more items, please print and include a second form.

 

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.

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 _________________________

 

 

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.

_____________________________________________________________________________

BlindSpotMapping.com   -   Int'l Phone: 530.949.1353