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    Capno BP Order Form

    Uploaded by

    Michael Grant White
    This document is an order form from Better Physiology, Ltd. It lists various respiratory physiology equipment and instructional systems along with their prices. It also provides fields to enter customer information like name, shipping address, payment details, and special instructions. The customer can choose items to purchase, enter the quantity of each, and see a total price calculated at the bottom. Graduate programs in breathing sciences from the affiliated school are also listed for prospective students.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Capno BP Order Form

    Uploaded by

    Michael Grant White
    61 views1 page
    This document is an order form from Better Physiology, Ltd. It lists various respiratory physiology equipment and instructional systems along with their prices. It also provides fields to enter customer information like name, shipping address, payment details, and special instructions. The customer can choose items to purchase, enter the quantity of each, and see a total price calculated at the bottom. Graduate programs in breathing sciences from the affiliated school are also listed for prospective students.

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    Order Form.

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    This document is an order form from Better Physiology, Ltd. It lists various respiratory physiology equipment and instructional systems along with their prices. It also provides fields to enter customer information like name, shipping address, payment details, and special instructions. The customer can choose items to purchase, enter the quantity of each, and see a total price calculated at the bottom. Graduate programs in breathing sciences from the affiliated school are also listed for prospective students.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    61 views1 page

    Capno BP Order Form

    Uploaded by

    Michael Grant White
    This document is an order form from Better Physiology, Ltd. It lists various respiratory physiology equipment and instructional systems along with their prices. It also provides fields to enter customer information like name, shipping address, payment details, and special instructions. The customer can choose items to purchase, enter the quantity of each, and see a total price calculated at the bottom. Graduate programs in breathing sciences from the affiliated school are also listed for prospective students.

    Copyright:

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    Download as PDF, TXT or read online from Scribd
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    ORDER FORM

    Better Physiology, Ltd.


    7 Camino de Rey Circle, Santa Fe NM 87506 USA
    Tel: 505.820.3376 Fax: 505.213.0351 instruments@betterphysiology.com

    Who referred you? ______________________________________

    CapnoTrainer M: $3,300.00 X ____ (number of units): $____________


    CapnoTrainer M: $3,500.00 with starter kit X ____ (number of units): $____________
    CapnoTrainer M: $3,900.00 with starter kit X ____ (number of units): $____________
    AND, extended warranty 2-year replacement program (covers accidental damage and misuse)
    CapnoPlus (EMG, ECG, HRV): $850.00 X ____ (number of units): $____________
    Capno-4 Group Instructional System: $15,500.00 X ____ (quantity): $ _____________
    Capno-8 Group Instructional System: $31,000.00 X ____ (quantity): $ _____________
    Nasal cannulas (pack of 100): $100.00 X ____ (number of packs): $____________
    Capno Filters (pack of 12): $54.00 X ____ (number of packs): $____________
    DVD Respiratory Fitness Series (four 1-day Workshops): $500.00 X ____ (qty): $____________
    TOTAL PRICE: (shipping will be added to this amount): $ _______________

    Graduate School of Breathing Sciences: www.breathingsciences.bp.edu.


    Send me information about CE courses (for registration: www.e-campus.bp.edu).
    Send me information about the MS degree program in Applied Breathing Sciences.
    Send me information about the Behavioral Biofeedback Certificate Program.

    Customer name _________________________________________

    Name to appear on invoice __________________________________________

    Shipping Address _______________________________________________________________

    _____________________________________________________________________________

    Phone ___________________________ Fax _____________________________

    Email _________________________________________

    Method of Payment

    Credit card: Number ______________________________________ (VISA, MC, Discovery, AMEX)


    Exp. date _____________________ 3-digit code on backside _______ (4-digit for AMEX on front side)

    PayPal: Please send me a request at the following email address ______________________________

    Special notes or instructions:

    _______________________________________________________________________________

    _______________________________________________________________________________

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