NEPTUNE™ Order Form
Recipient Name:
Option Certificate No.:
Name of Guardian(s) if recipient is under 18 years of age:
Recipient Address:
Street
City
Recipient Phone No.:
Zip
Recipient Email:
Center Name:
Standard Components: Universal Headpiece (UHP), Clip, Carrying Case, Travel Case, Dry & Store, Dry-Brik, Battery Charger, AAA Rechargeable Battery (4 each), AAA
Alkaline Battery (8 each), AquaMic, Neptune Connect Wallet, Audio Cable (Adult only), Earbuds (Pediatric only)
OPTION #1
Neptune Band Finish (select one):
Bright Chrome
OPTION #7
AquaMic Cable Length & Color
(select up to two):
Satin Chrome
OPTION #2
Neptune Connect Color (select one):
6”
12”
18”
24”
32”
42”
Black
6”
12”
18”
24”
32”
42”
OPTION #8
Neptune Processor Pouch (select one):
Neptune Pouch (fits processor and controls)
White
Neptune without Neptune Connect
waterproof configuration
(select up to two additional, first color will match your Neptune Connect [black or white]):
Alpine White
Onyx
Lime Green
Princess Pink
Sky Blue
Ocean Blue
Ruby Red
Tropical Sea
Sand Castle
OPTION #4
Universal Headpiece (UHP) Color Cap
Wild Violet
Non-waterproof
Alpine White
Onyx
Sand Castle
Wild Violet
Lime Green
Princess Pink
Sky Blue
Gray
Ocean Blue
Ruby Red
Tropical Sea
Raspberry
Dark Sienna
Dark Brown
Beige Metallic
OPTION #5
UHP Cable Length & Color
Pink
Blue
Graphite
Neptune Mini Pouch (fits processor only)
Pink
Blue
Graphite
Neptune Pouch
Neptune Mini Pouch
OPTION #9
Wearing Style (select two of the following):
(select up to three colors):
Armband
Standard
Small
Lanyard
Standard
Small
Armband
Non-waterproof
Lanyard
Swim Wear Style
Swim Cap
Blue
(select up to two):
Swim Cap
Purple
Headband
Standard (Graphite)
White
6”
12”
18”
24”
32”
42”
Black
6”
12”
18”
24”
32”
42”
Beige
6”
12”
18”
24”
32”
42”
Brown
6”
12”
18”
24”
32”
42”
OPTION #6
AquaMic Color Cap
AquaMic & Color Caps are waterproof
(select two colors):
Small (Pink, suggested age: less than 4 years old)
Small (Blue, suggested age: less than 4 years old
Headband
OPTION #10
Processor Harness
(Pediatric only, suggested age, 3 years or younger):
None
Alpine White
Brown
Onyx
Beige
027-M080-03
White
Non-waterproof
Black
OPTION #3
Neptune Color Cover
Waterproof
Grey
©2012 Advanced Bionics, LLC and its affiliates. All rights reserved.
Pink
Blue
AdvancedBionics.com