| Hand Held Computer Order Form | ||||||||
| Name: | email: | |||||||
| Class: | ||||||||
| Visor Deluxe | ||||||||
| Please circle color of visor: | Price: | |||||||
| Graphite | Check here to order: | |||||||
| Blue | (estimated cost = $230) | |||||||
| Green | ||||||||
| Orange | ||||||||
| Ice | ||||||||
| Apothecarium Package | ||||||||
| (Costs based on number sold) | Price: | |||||||
| 200 | $55 | Check here to order: | ||||||
| 100-199 | $61 | (regularly $110) | ||||||
| 50-99 | $66 | |||||||
| 20-49 | $72 | |||||||
| 5 Minute Clinical Consult | ||||||||
| (Costs based on number sold) | Check here to order: | Price: | ||||||
| 200 | $50 | |||||||
| 100-199 | $55 | (regular $65) | ||||||
| 20-99 | $60 | |||||||
| Patient Keeper | ||||||||
| (Costs based on number sold) | Check here to order: | Price: | ||||||
| > 50 | $20 | |||||||
| 20-49 | $25 | (regularly $35) | ||||||
| Serial Port Cradle | ||||||||
| Check here to order: | Price: | $29 | ||||||
| Please specify the format of your computer: Mac PC | ||||||||
| If you already have a handheld, specify your platform: Windows CE Palm OS | ||||||||
| Once order forms have been received, an e-mail will be sent to you with the cost. | ||||||||