ORDER FORM
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Print out order form, fill out accordingly, save as PDF and  email to astralite@earthlink.net. You are more than welcome to call order in @ 800-368-5483 OR 831-539-9886 Monday through Friday, 10:00 am to 5:00 pm Pacific standard time.

 

1) PRO LIGHTWEIGHT PORTABLE SERIES: (click here to see model) 
____LUMINA III @24.5 lbs.    29.5 X 73" BLACK $ 620.00 
____STARLITE III @ 23.5 lbs. (10.66 kg)   27.5 X 73" BLACK $ 620.00 
____PULSAR III @ 21.0 lbs. ( 9.53 kg)   25.5 X 69" BLACK $ 620.00 
1a) LEG HEIGHT:  (Height indicate working surface of table)

____19) 23-32" (58-81 cm)    ____21) 25-34" (64-86 cm)

$ N/C
2) SUPER LIGHTWEIGHT SERIES: (click here to see model)
____VENUS III @ 22.5 lbs. (10.21 kg)   29.5 X 73" BLACK $ 520.00 
____MERCURY  III @ 21.5 lbs. (9.75 kg)   27.5 X 73" BLACK $ 520.00 
____TAURUS  III @ 20.75 lbs. (9.41kg)   25.5 X 73" BLACK $ 520.00 
2a) LEG HEIGHT:  (Height indicate working surface of table)

____L) 22.5-31.5"                     _____T) 24.5-33.5" 

$ N/C

3) TABLE OPTIONS: 
**
Not available on the Portable Chiropractic Series tables.  

____**Extra 3/4" Foam ; Add 2 lbs.  $  75.00 
____**Full Adjustable Tilting Head Cradle ; Add 1.5 lbs. (Includes C 3 P  face pillow) $  95.00
____**Standard Non Adjust Head Cradle ; Add 1.5 lbs. (Includes C 3 P  face pillow) $  65.00

3a) CUSTOM TABLE OPTIONS: 

These items make SALE FINAL.
  

____**ULTRA-LEATHER Material (This option makes SALE Final, and is NOT AVAILABLE on the Portable Lightweight Chiropractic Series tables)                                    ____Raven Wing    

$ 225.00
____Arm Support Extender Set (Can not be ordered POST production) $  85.00
____Foot Support ; Add 2 lbs. (Can not be ordered POST production) $  80.00
____Foot Support Holes Only (Can not be ordered POST production) $  25.00 NET
 
4) ACCESSORIES: (click here to go to accessory page)
____MIT Bolster           $  50.00
____MIT Bolster in Ultra-Leather             $  80.00
____ZB Head Support     $  40.00
____ZB Head Support in Ultra-Leather  $  60.00
____Arm Support Extender Set (Can not be ordered POST production) $  85.00
____Head Cradle Loft $  35.00
____Head Cradle Loft Ultra-Leather      $  45.00
____Head Cradle Arm Rest   $  45.00
____Head Cradle Arm Rest Ultra-Leather     $  70.00
____C3P Face Pillow     $  35.00
____C3P Face Pillow in Ultra-Leather                           $  55.00
 
5) PORTABLE LIGHTWEIGHT CHIROPRACTIC Series: (click here to see model)
All tables in this series include in cost the 5 position head piece. Measurements below include the
12" of length with Head Cradle set up.  
____CHIROPORT III @ 16 lbs. 17.5 X 53" long; 65" BLACK   $ 510.00 
____CHIROPORT-20  @ 16.5 lbs.  20 X   65" BLACK $ 510.00 
____CHIROPORT-22  @ 17 lbs.  22 X   65"  BLACK $ 510.00 
____CHIROPORT-BN  @ 19 lbs. 22 X   71" BLACK $ 550.00 
____Lock Rod (Included at no charge with the Chiroport III-BN model) $  75.00 
____Foot Support ; Add lb. (SALE Final) (Can not be ordered POST production) $  80.00
____Foot Support Holes Only (SALE Final) (Can not be ordered POST production)                       $  25.00 NET
____Arm Support Extender (SALE Final) (Can not be ordered POST production) $  85.00
____Head Cradle Arm Rest     $  45.00
____Vinyl Cover; For all model CHIROPORT's only. 
                    Size: CHIROPORT-III_____       Chiroport 20/22______   Chiroport BN_____
$  85.00
____Additional Head Cradle Pad Set;  Curved___   Straight___ (curved set included with table purchase.) $  35.00
 

 SUBTOTAL   

$______._____

  CA Tax (If shipped in California; Call for Rates)    

$______._____

 SHIPPING (See Shipping Chart)   

$______._____

    Total due   

$______._____
All information in Blue must be filled in to complete order. For questions, contact us at 800-368-5483, or 831-763-0397, or email us.
Billing Information:
BILLING NAME:_____________________________________________
ADDRESS:___________________________________________________
CITY, ST:_____________________________ ZIP CODE:_____________ COUNTRY:__________________________
PHONE (______)_________________    FAX(______)__________________
EMAIL:__________________________________

Note: For credit card orders, billing information must be the same as on credit card statement.

Shipping Information: ____Same as Billing address
NAME:_____________________________________________
ADDRESS:___________________________________________________
CITY, ST:_____________________________ ZIP CODE:_____________ COUNTRY:__________________________
PHONE (______)_________________  FAX(______)__________________
EMAIL:__________________________________

Method of Payment:     VISA         MC         DISCOVER        AMX          
CREDIT CARD #__________-__________-__________-_
_________
EX. DATE:_______/________ CVC code________________
SIGNATURE:_____________________________________
*This warranty does not include damage caused by accident, misuse or neglect. ****You may return your order within 30 days for a full refund excluding shipping in original packaging.  Prices are subject to change without notice.  ALL RETURNS ARE SUBJECT TO A 15% RESTOCKING FEE/ OR ONCE ITEM IS IN PRODUCTION, WITH A MINIMUM FEE OF $10.00 APPLICABLE AND ANY BANKING FEES THAT APPLY. WE RESERVE THE RIGHT TO REFUSE SERVICE TO ANYONE. WE ALSO RESERVE THE RIGHT TO SUBSTITUTE ADVERTISED MANUFACTURED GOODS WITH LIKE OR SIMILAR PRODUCTS.

Updated 4/21/17