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FOR EASY ORDERING: COPY THIS PAGE, CIRCLE WHAT YOU NEED, AND FAX TO US<br />
FAX TO (574)259-2102 OR (574)259-2103 DATE: / /<br />
OFFICE OR DOCTOR: ORDERED BY: PHONE: ( ) -<br />
ADDRESS: CITY: STATE: ZIP:<br />
CHARGE TO (CIRCLE) CC NUMBER: EXP: / 20<br />
CHARGE TO MY BERNELL ACCOUNT NUMBER:<br />
NAME ON CC:<br />
MOST FREQUENTLY ORDERED ITEMS - PLEASE CIRCLE THE QUANTITY AND PRICE OR FILL IN THE BLANK OF THE ITEMS FOR QUICK-ORDER<br />
PAGE QUANTITY PART NUMBER DESCRIPTION PRICE<br />
5 GECAX Projector Bulbs GE 1@$7.95 - 6@$7.65 - 12@$6.99 - 48@$6.95<br />
5 LTCAX Projector Bulbs Imported 1@$5.25 - 12@$4.50 - 48@$3.75<br />
5 CM720 Battery for Welch/Allyn Ophthalmoscope $22.95<br />
5 CM722 Battery for Propper Ophthalmoscope $28.95<br />
1 NOPMS Post Myd Specs - Adult Amber 250@32¢ - 500@30¢ - 1000@25¢ - 2500@23¢<br />
1 NOPMSGY Post Myd Specs - Adult Gray 250@33¢ - 500@31¢ - 1000@26¢ - 2500@24¢<br />
1 NOPMSCH Post Myd - Child Amber 250@32¢ - 500@30¢ - 1000@25¢ - 2500@23¢<br />
80-81 STROBE Nike Vapor Strobe Call<br />
1 ROLLENS Rollens Post Myd Wraps 100@40¢ - 500@36¢ - 1000@33¢ - 2500@32¢<br />
1 SAPMS Solarettes Post Myds 100@35¢ - 500@32¢ - 1000@30¢<br />
11 SNEP2S Probe Caps - Sterile 1 box - 100@ $46.50 3 boxes - 100@ $45.50<br />
11 SNEP2X Probe Caps - Bulk Sanitary, but not Sterile 1 box - 900@ $53.25 3 boxes - 900@ $51.25<br />
2 AK43D6DS Flurasafe ® (6mL) Benoxinate & Lg Fluorescein 4 @ $9.95 12+ @ $9.50<br />
2 AK49D5DS Flurox ® (5mL) Benoxinate & Fluorescein 5 @ $8.75 12+ @ $8.50<br />
8 SF3E Black Eye Patches - Large Elastic 12 @ $14.50<br />
8 SF5EC Bright Colored Eye Patches - Small 6 @ $12.95<br />
8 SF3ES Black Eye Patches - Small Elastic 12 @ $15.50<br />
66 BC1270100 Flipper +/- 1.00 @$17.50<br />
66 BC1270150 Flipper +/- 1.50 @$17.50<br />
66 BC1270200 Flipper +/- 2.00 @$17.50<br />
66 BC1270250 Flipper +/- 2.50 @$18.50<br />
74 BC1180 Original Model R/G Goggles Package of 6 @ $24.25<br />
74 BC1186 Child Sized Goggles Reversible R/G Package of 6 @ $22.25<br />
74 BC1185 Modern Goggles R/G Package of 6 @ $23.25<br />
14 WC70206 Disposable Penlights - Package of 6 1 pkg @ $8.25 - 4 pkg @ $7.25 - 12 pkg @ $6.95<br />
PAGE QUANTITY PART NUMBER DESCRIPTION PRICE<br />
NORMAL SHIPPING AND HANDLING WILL BE ADDED TO YOUR ORDER (SEE BACK PAGE FOR PRICING).<br />
YOU MUST CALL IN YOUR PRIORITY MAIL OR RUSH ORDERS BEFORE 2PM EST! ALL PRICING IS SUBJECT TO CHANGE.<br />
KEEP A COPY FOR YOUR RECORDS.
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