TEST OF VARIABLES OF ATTENTION (T.O.V.A.®) ORDER FORM
Contents
1. 0 each All US funds FOR TTC USE ONLY SERIAL Microswitch Sale Rep Source Tracking TEST OF VARIABLES OF ATTENTION T O V A Ordering Form and Process Information T O V A Report Types Clinical Version A graduate degree in medicine psychology counseling or closely related field that includes advanced training in the administration and interpretation of tests and a license or certificate by a state agency Screening Version At least a BA in Psychology counseling or a closely related field and relevant training or coursework in the interpretation of tests and measurement at an accredited college or university OR Verification of membership in a professional association recognized to require training and experience in the ethical and competent use of tests OR Certified by an agency which does the same If a version is not checked or proper degree not listed in contact information a SCREENING version may be sent The T O V A 8 requires a computer that has Linux An x86 or x86 64 processor running at 1 GHz or better e Linux 2 6 13 or newer Note Linux installations are only partially supported 512 MB or more of memory please inquire for more information e 100 MB or more of hard drive space External Audio Video EAV Setup One free USB port on the computer not on an external USB hub EAV setups allow the user to administer the T O V A without rebooting The T O V A 8 requires a display that Requires an externa2. TEST OF VARIABLES OF ATTENTION T O V A ORDER FORM SENDING OPTIONS Mail The TOVA Company Fax 800 452 6919 or 562 594 7770 3321 Cerritos Ave For assistance call 800 729 2886 or 562 594 7700 Los Alamitos CA 90720 Owner If different from shipping Ship To Bill To Attention Attention Address Address Clinical Contact Billing Contact Clinical Email Billing Email Clinical Phone Billing Phone Clinical Fax Billing Fax T O V A VERSION please check one _JCLINICAL Degree amp License LISCREENING Non licensed clinicians Degree Type of Facility Setting How did you hear about T O V A Internet Colleague L Patient Conference LI Workshop LI Mailer Email J Other Please send please check items below Prices subject to change ADDITIONAL MATERIALS Operating System s MAC Windows Optional not Included with kits L T O V A 8 Kit O T O V A Sync Interface 300 00 QTY T O V A USB Hardware Allows users to precisely synchronize events in the T O V A test with other lab User s Manual or clinical equipment Install Boot cD z Four available events if the test is being administered if the stimulus is being Five Test Credits displayed if the stimulus is a target or nontarget and if the microswitch is being 695 00 each Shipping pressed Events are available as either four separate digital logical signals or as a O T O V A Research Laptop combined multi level a
3. We verify all credit cards and addresses to protect the card holders To avoid processing or shipping delays please consider the following Billing information Use the billing information for future billing For the telephone number list the billing contact Credit Card Information Use the exact info from the credit card statement For the telephone number use what s on file with the card issuer Shipping Information The shipping name address and main phone number must be verifiable in an online telephone directory or Internet search If not the shipping address has to be listed with the credit card as either the billing or alternate shipping address End User Information If the end user is not listed in billing or shipping contacts please include them somewhere on the form so that we can provide effective service and support Delivery To complete a secure shopping experience all deliveries may require a signature upon receipt
4. atible designs Additional Scoring Credits Scoring credits are used by the T O V A program whenever a test has been given in order to receive results T O V A kits come with 5 scoring credits ready to be used Additional scoring credits are purchased through The TOVA Company Cost per scoring credit after the initial five is 15 00 each domestic and 10 00 each international Allin US funds T O V A test credits ordered during any one month s time period will be billed the following month There are Special Rate Programs available for selected Research Training Educational amp Government facilities however pre approval is required and there is an application process Please contact The TOVA Company for more information Shipping T O V A kits cost is 34 95 for domestic shipping For optional or additional materials please add 10 for domestic US to shipping cost International orders cost 80 00 minimum US funds only International shipments are shipped the fastest possible way Contact The T O V A Company for an international shipping quote or if you have special service requests The TOVA Company Is not responsible for any duties fees or taxes that may occur with customs Schedule Most orders placed before 11AM Friday are processed and shipped that week pending verification and inventory Actual FedEx delivery time from our CA office can be another 1 6 business days depending on the destination Expedited requests will be shipped fast
5. er than standard Returns The TOVA Company offers a 30 day money back guarantee If you are not satisfied for any reason simply return the complete kit within 30 days of purchase for complete refund less shipping amp any additional tests used After 30 up to 90 days we will accept returned kits however an additional 20 restocking fee will be deducted from the kit refund Payment The T O V A Company accepts American Express Visa MasterCard and Discover credit Paypal checks or money orders See Payment Terms for more details Please make checks or money orders payable to THE TOVA COMPANY We accept U S dollars only Do not send cash Purchase Order Customers If a proforma invoice or quote is needed please contact The T O V A Company we will be happy to provide any information you require Please send hard copy of purchase order with order Bank Check Or Wire Payments Senders are responsible for any fees deductions or currency exchange shortages that may be removed from payments before they are received by The TOVA Company Please specify to your bank or institution to state write ALL CHARGES OURS or NO CHARGES FOR BENEFICIARY written in English and YOUR language if different in your sending instructions BankName 0 CPITIBANK Banker Branch 2800 Seal Beach Blvd Suite E Seal Beach CA 90740 Bort Code IBAN No SWIFT CODE ITIUS33 ontact TTC for account ABA Routing Number ontact for TTC routing Verification
6. l monitor and speakers as on a desktop computer is equal to or greater than 10 inches measured diagonally A VGA video port on the host PC is strongly recommended has a resolution of 1024 x 768 pixels or better Precision Test Environment PTE Setup Operating System Requirements The T O V A 8 can run on the following The PTE setup allows administering the T O V A test on a computer without an Operating systems external monitor such as a laptop This requires rebooting the computer into the Windows T O V A 8 PTE Windows XP 32 bit SP2 or better Requires a graphics card that supports 1024 x 768 x 16 bit video mode Windows Vista all versions Bluetooth keyboards and mice are not supported For example this means that Windows 7 all versions the wireless keyboard shipped with the Apple iMac will not work Mac Apple computers require the included T O V A boot CD or a T O V A flash Mac OS X 10 6 2 or newer drive to enter the PTE e MacBook Air users must have an external optical drive or order a T O V A flash Note that drive to use the Precision Test Environment PTE Most netbook and many ultraportable laptops do not meet the screen size e iMac users must use a USB keyboard not a wireless keyboard in order to use and resolution requirements and thus will not work with the PTE the Precision Test Environment PTE We don t recommend Toshiba Satellite or Satellite Pro laptops because of their often incomp
7. nalog signal on a single channel QTY The T O V A TRL is a dedicated portable T O V A testing system for O T O V A flash drive 29 95 research that falls under regulations such as 21 CFR Part 11 The system is a laptop that has been tested and certified by The TOVA Company to collect L External Speakers Set 29 95 T O V A data in highly regulated environments such as clinical trials pharmaceutical research and forensic cases 3000 00 each Shipping Total From Above PAYMENT CA MN WA residents please include Sales Tax C CHECK OR MONEY ORDER PAYABLE The TOVA Company LI PURCHASE ORDER P O P aod O PayPal Account ID Additional Test Credits 15 00 each O Visa MasterCard Discover Card American Express QTY x 15 00 Card Holder Name Shipping Cardholder Billing Address Same as above Sub Total Promo Code All Funds are US currency Total Shipping 34 95 Domestic US 80 00 Minimum for International Card Final shipping depends on destination Call TTC for quote or Expiration Date MO YR proforma invoice Shipping does not include any duties taxes or fees that may occur with customs Expedite add 10 00 Card Verification Number 3 4 digits on front back Add 10 for additional weight TAdditional credits are purchased through The T O V A Company Cost per test credit after the initial five is 15 each Authorized Signature International discount 1
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