BE Adaptive Mail-In Order Form

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

Check Appropriate

High Quad Unit_____________
HQ100
$1650 + $65.00 Shipping

SCS Scope Camera System
$699.00 + $35.00 shipping and handling.____________

Bite Trigger Mechanism [Front Trigger Safety]
BT100
$180.00 + $15.00 Shipping__________________

Bite Trigger Mechanism [Rear Trigger Safety]
BT100
$180.00 + $15.00 Shipping__________________

Bite Trigger Plate Only  [Front Trigger Safety]
BTP100
Extra plates: $20.00 + $5.00 Shipping_______

Bite Trigger Plate Only [Rear Trigger Safety]
BTP100
Extra plates: $20.00 + $5.00 Shipping________

Limited Mobility Unit_________
LM100
$475.00 + $35.00 Shipping

Power Trigger Mechanism________
TM100
$250.00$15.00 Shipping

Finger Control Hand Device (without additional wrist support)
HD100
$65.00 + $8.00 Shipping
Right Handed________Left Handed_________
 

Finger Control Hand Device (with additional wrist support)
HD200
$75.00 + $8.00 Shipping
Right Handed________Left Handed_________
 

Bush-N-a-BAG Hide in the open with this innovative suit. Doubles as a blind, plus many other uses ! $149.95 Includes Shipping. Shipping listed is for continental US only, if you need it shipped somewhere else, contact us for a shipping quote._____________

Quantity: _______ x $

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


 


If you have any questions, comments, or concerns, please call 877-595-5634

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