BE Adaptive Mail-In Order Form

 
Print this order form, and mail to the address listed below:

Check Appropriate

High Quad Unit
HQ100
$1950.00 + $68.00 Shipping _______

High Quad Pistol Mount

HQPM $285.00 + $20.00 Shipping _______________

 Safety Pendant – Additional safety switch

Safety Pendant $62.00 + $18.00 Shipping ________

 Hand Controls for HQ100

HQ100 Hand Controls $350.00 + $20.00 Shipping __________

 Seat Pan

Seat Pan $98.00 + $20.00 Shipping ____________

 SCS Scope Camera System

SCS $805.00 + $35.00 Shipping _________________

 Bushings for SCS Scope Camera System

Bushing for SCS $85.00 + $10.00 Shipping ____________

 Drive on Stand

Drive on Stand $365.00 + $65.00 Shipping ________

Bite Trigger Mechanism [Front Trigger Safety]
BT100
$225.00 + $20.00 Shipping__________________

Bite Trigger Mechanism [Rear Trigger Safety]
BT100
$225.00 + $20.00 Shipping__________________

Bite Trigger Plate Only  [Front Trigger Safety]
BTP100
Extra plates: $32.00 + $8.00 Shipping_______

Bite Trigger Plate Only [Rear Trigger Safety]
BTP100
Extra plates: $32.00 + $8.00 Shipping________

Compound Bow Mount

CB100 $580.00 + $48.00  Shipping ______

 

Draw Loc

Draw Loc $199.00 + $18.00 Shipping ______

Limited Mobility Unit_________
LM100
$580.00 + $48.00 Shipping

Limited Mobility Pistol Mount

LMPM $318.00 + $20.00 Shipping ______

Power Trigger Mechanism________
TM100
$318.00$20.00 Shipping

Finger Control Hand Device (without additional wrist support)
HD100
$75.00 + $18.00 Shipping
Right Handed________Left Handed_________
 
Finger Control Hand Device (with additional wrist support)
HD200
$85.00 + $18.00 Shipping
Right Handed________Left Handed_________

Tabletop Tripod

Tabletop Tripod $250.00 + $20.00 Shipping _______

 

Limited Mobility Fishing Mount

FM200 $580.00 +$48.00 Shipping ___________

 

Limited Mobility Fishing Mount with no seat pan

FM200 with no seat pan $535.00 + $48.00 Shipping __________

 

Reel Cranker Hand Device (Without Additional Wrist Support)

RC100 or RC150 $75.00 + $18.00 Shipping

Right Hand ____________  Left Hand ____________

 

Reel Cranker Hand Device (With additional wrist support)

RC200 or RC250 $85.00 + $18.00 Shipping

Right hand __________ Left Hand ________

Bush-N-a-BAG Hide in the open with this innovative suit. Doubles as a blind, plus many other uses ! $159.95 + $10.00 Shipping. Shipping listed is for continental US only, if you need it shipped somewhere else, contact us for a shipping quote._____________

Quantity: _______ x $

Item:__________

Item:__________

Item:__________


Ship To:

Name:  ____________________________________________

Street Address: _____________________________________

___________________________________________________

City:  _____________________   State:  ____    Zip Code:  ___________
 


E-mail:
__________________________
 


Phone:
__________________________
 


Subtotal (Quantity x $               ): _______.____

 Shipping________.____

Total: _______.____
 


Mail Form, along with your check or money order to:
BE Adaptive LLC 2008

BE Adaptive Equipment LLC,
P.O. Box 84,Columbia City, IN 46725  
Phone: 877-595-5634 - Fax: 260-244-4953