ORDER FORM

 

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 Head Cradle/Face Holes    Options     Accessories
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Print out order form, fill out accordingly, and fax or send in with check to address above. You are more than welcome to call order in @ 800-368-5483 Monday through Friday, 9:00 am to 4:30 pm Pacific time.

 
1) PROFESSIONAL SERIES: (click here to see model)
____QUASAR III @27.5 lbs. (12.47 kg)

33.5 X 73" (86 cm X 185 cm)

 $ 540.00 
____LUMINA III @24.5 lbs. (11.11 kg)

29.5 X 73" (75 cm X 185 cm)

 $ 530.00 
____STARLITE III @ 23.5 lbs. (10.66 kg) 27.5 X 73" (70 cm X 185 cm) $ 520.00 
____PULSAR III @ 21.0 lbs. ( 9.53 kg) 25.5 X 69" (65 cm X 175 cm) $ 510.00 
1a) LEG HEIGHT:  (Height indicate working surface of table)
____17) 21-30" (53-76 cm)
____18) 22-31" (56-79 cm)		 ____19) 23-32" (58-81 cm)
____21) 25-34" (64-86 cm)
$ N/C

 
2) SUPER LIGHTWEIGHT SERIES: (click here to see model)
____COSMOS III @ 25.5 lbs. (11.57 kg)

33.5 X 73" (85 cm X 185 cm)

 $ 430.00 
____VENUS III @ 22.5 lbs. (10.21 kg)

29.5 X 73" (75 cm X 185 cm)

 $ 425.00 
____MERCURY  III @ 21.5 lbs. (9.75 kg) 27.5 X 73" (70 cm X 185 cm) $ 420.00 
____TAURUS  III @ 20.75 lbs. (9.41kg) 25.5 X 73" (65 cm X 185 cm) $ 415.00 
2a) LEG HEIGHT:  (Height indicate working surface of table)
____L) 22.5-31.5" (57-80 cm)     _____T) 24.5-33.5" (62-85cm) $ N/C
 
3) STATIONARY SERIES: (click here to see model)
____VENUS Stat III @ 31.25 lbs. ( 14.17 kg)

29.5 X 73" (75 cm X 185 cm)

 $ 320.00 
____MERCURY Stat III @ 29.25 lbs. (13.27kg) 27.5 X 73" (70 cm X 185 cm) $ 315.00
____TAURUS Stat III @ 27.25 lbs. ( 12.36 kg) 25.5 X 73" (65 cm X 185 cm) $ 310.00 
3a) LEG HEIGHT: (Height indicate working surface of table)
____L) 22.5-31.5" (57-80 cm) ____T) 24.5-33.5" (62-85cm) $ N/C
 
4) CHIROPORT: (click here to see model)
____CHIROPORT III @ 16 lbs. (7.26 kg)
(Includes 5 position head piece. Available in Levante Vinyl only.)

17.5 X 53" (45 cm X 135 cm)

 $ 400.00 
____CHIROPORT III-20  @ 16.5 lbs. (7.48 kg)
 (Includes 5 position head piece. Available in Levante Vinyl only.)

20 X   53"  (51 cm X 135 cm)

 $ 405.00 
____CHIROPORT III-22  @ 17 lbs. (7.71 kg)
 (Includes 5 position head piece. Available in Levante Vinyl only.)

22 X   53"  (56 cm X 135 cm)

 $ 410.00 
____CHIROPORT III-BN  @ 19 lbs. (8.62 kg)
 (Includes 5 position head piece and Lock Rod accessory. Available in Levante Vinyl only.)

22 X   59"  (56 cm X 150 cm)

 $ 460.00 
____Foot Cutout For Chiroport-BN table (Cost Non-Refundable if table returned) $  45.00
____Lock Rod (Included with the Chiroport III-BN model) $  40.00 Net
____Foot Support ; Add lb. (.45 kg) (Cost Non-Refundable if table returned) $  62.00
____Arm Support Set (Cost Non-Refundable if table returned) $  52.00
____Cotton/Poly Pad Covers; (Set of 2)     $   9.00/ Set                           1/2 Dozen $  45.00
____Travel Case (in Charcoal Grey only) For CHIROPORT III and 22 $  75.00
____Travel Case (in Charcoal Grey only) For CHIROPORT III-BN $  82.00
 
5) LEVANTE  UPHOLSTERY COLORS: (See color Sample chart)
____Hunter         ____Black         ____Jade          ____Agate          ____Burnt Rose  

____Burgundy      ____Teal        ____Mushroom        ____Flint Grey        ____White 		  
N/C
 
6) ULTRA-LEATHER COLORS: (See color Sample chart)  Subtract 1 lb (.45 kg)
____Juniper     ____Baltic     ____Berry    ____Brick    ____Shetland    

____Papyrus    ____Raven Wing    ____Dove Grey    ____Marine    ____Plum
$ 125.00
 

7) CUSTOM TABLE OPTIONS: 
(These items make SALE FINAL)
____Regular Face Hole only              $ 52.00 With Plug        $ 64.00
  ____In Ultra-Leather             $ 96.00 With Plug        $118.00
____Crescent Face Hole only             $ 90.00 With Plug        $110.00
  ____In Ultra-Leather             $130.00 With Plug        $170.00
____Foot Support ; Add 1.75 lbs. (.79 kg) $  62.00
____Foot Support in Ultra-Leather ; Add 1.5 lbs. (.68 kg) $  93.00
8) OTHER OPTIONS:
____Extra 3/4" Foam ; Add 2 lbs. (.91 kg) $  15.00
____Extra FIRM Foam ; Add 2.5 lbs. (1.14 kg) SALE FINAL (Add $5.00 for Cosmos or Quasar model table) $  45.00 NET
____FIRM Landau Foam ; Add 1 lbs. (.45 kg) SALE FINAL (Add $5.00 for Cosmos or Quasar model table) $  55.00 NET
____4 MM Baltic Birch Ply ; Add 1.5 lbs. (.68 kg) $  20.00
____Maxi Tilt Head Cradle ; Add 1.5 lbs. (.68 kg)
 (Includes C 3 P  face pillow) Available on Super lightweight Series Only		 $ 105.00
____Full Adjustable Tilting Head Cradle ; Add 1.5 lbs. (.68 kg)
 (Includes C 3 P  face pillow)		 $  85.00
____Standard Non Adjust Head Cradle ; Add 1.5 lbs. (.68 kg)
(Includes C 3 P  face pillow)		 $  47.00
____Rubber Feet (in gray only) $ 15.00
____Other___________________________________________  
____________________________________________________ $      .
 
9) ACCESSORIES: (click here to go to accessory page)
Note: All items will be sent in table color unless otherwise noted.
____Travel Case (For all tables other than Chiroport Series tables.) $  85.00
____Knee Cushion / Color:           $  27.00
____Knee Cushion in Ultra-Leather/ Color:          $  51.00
____FLUFFY Bolster/ Color:              $  34.00
____FLUFFY Bolster in Ultra-Leather/ Color:             $  65.00
____MIT Bolster/ Color:              $  34.00
____MIT Bolster in Ultra-Leather/ Color:             $  65.00
____DM Bolster Set / Color:          $  37.00
____DM Bolster in Ultra-Leather/ Color:               $  71.00
____Neck Contour Cushion/ Color:           $  24.00
____Neck Contour Cushion Ultra-Leather / Color:           $  46.00
____Neck Cushion/ Color:           $  16.00
____Neck Cushion in Ultra-Leather/ Color:         $  29.00
____ZB Head Support / Color:     $  24.00
____ZB Head Support in Ultra-Leather/ Color:     $  46.00
____Arm Support Extender Set/ Color:   $  52.00
____Arm Support Extender Set in Ultra-Leather/ Color:                    $  92.00
____Shoulder Support / Color:   $  22.00
____Shoulder Support Set in Ultra-Leather/ Color:                    $  46.00
____Chest Support Set/ Color:   $  27.00
____Chest Support Set in Ultra-Leather/ Color:                    $  51.00
____Head Cradle Arm Rest/ Color:      $  29.00
____Head Cradle Arm Rest Ultra-Leather/ Color:       $  52.00
____C3P Face Pillow/ Color:      $  19.00
____C3P Face Pillow in Ultra-Leather/ Color:                             $  38.00
____Face Pillow Covers   QTY______ @ $7.00 each $____.___
____1/2 Dozen (6) Face Pillow Covers @ $ 35.00/ ½ dozen $____.___
____1 Dozen (12) Face Pillow Covers   @ $ 70.00/dozen $____.___
____Fitted Drawstring Sheet; White only $28.00
____Flat Sheet; White only $10.00
____Sheet Set; 1-Fitted and 1-Flat; White only $35.00

 SUBTOTAL   

$______._____

Special PROMO CODE____________    

<$       .     >

  CA Tax (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:     CHECK      M.O.      VISA      MC      DISCOVER      AMX 
  MAKE CHECKS PAYABLE TO: ASTRA-LITE INC.
* All personal or business checks must have ID number written on check with a physical address and phone number. No starter checks please.

CREDIT CARD #__________-__________-__________-__________
EX. DATE:_______/________
SIGNATURE:_____________________________________
RETURN POLICY: ALL ITEMS MAY BE RETURNED WITHIN 30 DAYS IN ORIGINAL PACKAGING FOR A FULL REFUND INCLUDING SHIPPING; THIS IS APPLICABLE IN THE CONTINENTAL U.S. ONLY AND IS NOT APPLICABLE ON STUDIO SERIES TABLES. ALL RETURNS MUST BE APPROVED BY ASTRA-LITE PRIOR TO RETURN AND IN LIKE NEW CONDITION.

Updated 7/2006