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





Price E

PBSI Station A

Software;  Reversible Occluder Glasses; Table Top Chin Rest





   PBSI Station  B

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





PBSI Station C

Software; Reversible Occluder Glasses; Hvy Duty Chin Rest





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  





 B Chin Rest

 HCRD2R Double Screw Clamp





4523C Reversible Metal Frame Occluding Glasses 

Optokinetic Flags:




Combo OPK



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


























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

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




*(Fax Order to Confirm International Fees)








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






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:

_____________________________________________________________________________   -   Int'l Phone: 530.949.1353