 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| Kits and Replacement Parts The cost of one Kit is $230.00. It is possible to order one or more Kits or replacement parts for the Kit. To order send a standard purchase order, FAX a copy of the order form below, or send a letter/email of intent to purchase to the address below. You will receive an invoice after the Kit(s) or replacement part(s) have been shipped, although pre-payment on these types of orders is preferred. Shipping Within the Continental U.S. The cost of shipping one Kit is $20.00. Expect two to three weeks delivery. If you need a Kit(s) or replacement parts sooner, please contact me directly to arrange special delivery. Shipping Outside the Continental U.S. This requires additional charges. Please call or email to request that information. PayPal You can also order with a credit card via PayPal. Credit card or PayPal users are charged a $10.00 processing fee within the Continental U.S. The processing fee for outside the Continental US varies. Please call or email for exact cost of processing. Multiple Kits and Replacement Parts For orders of three or more Kits or a large quantity of replacements parts there is a discount price available. For multiple Kit or replacement part orders, quick delivery orders, outside the continental U.S. Kit delivery, please call or email for special discount and/or shipping costs. Zimmerman Low Vision Simulation Kit ORDER FORM Name: ________________________________________________
______________________________________________________ Phone: ________________________________________________ Email: _________________________________________________ Billing Address: _________________________________________ ______________________________________________________ Phone: ________________________________________________ Email: _________________________________________________ Purchase Order Number: __________________________________ A. Zimmerman Low Vision Simulation Kit ______ Kit(s) @ $230.00 per Kit = ________
Total A= ________ B. Replacement Parts 20/70 Acuity Lens (Red) _____ @ $25.00 each = ________ 20/200 Acuity Lens (Black) _____ @ $25.00 each = ________ 20/400 Acuity Lens (Blue) _____ @ $25.00 each = ________ 20/600 Acuity Lens (Green) _____ @ $25.00 each = ________ Field Restriction Funnels: 3°_____ @ $15.00 each = ________ Field Restriction Funnels: 7°_____ @ $15.00 each = ________ Field Restriction Funnels: 10°_____ @ $15.00 each =________ Macular Degeneration Near Lens _____ @ $15.00 each = ________ Macular Degeneration Distance Lens ____ @ $15.00 each = _______ Cataract Lens _____ @ $15.00 each = ________ Hemianopsia Lenses (2) _____ @ $15.00 = ________ Retinal Detachment Lens _____ @ $15.00 each = ________ Goggles _____@ $15.00 per pair each = ________ Black Occluder Lens _____ free = ________ Carrying Case _____ @ $35.00 each = ________ Foam Insert _____ @ $15.00 each = ________ + shipping/handling (see above) = ________ Total A ________ + Total B ________ Grand Total = ________
5700 Bunkerhill Street # 2208 Pittsburgh, PA 15206-1182 lowvisionsimulationkit@yahoo.com fax: (412) 487-8365 phone: (412) 487-2818 Under Construction ... Order SOON using PayPal! |
