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Order Form
You can purchase ACTiSYS products in several ways:
-Call us directly:
1-510-490-8024
-Fax in your order at 1-510-623-7268
Online purchasing below:
Models You Want to Buy
ACTiSYS Model#
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:
Quantity
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:
*If order ACT-IRxxxE, please enter ACT adapter as a separate entry with the dollar zero and specify country type
ACTiSYS Model#:
Quantity:
ACTiSYS Model#:
Quantity:
ACTiSYS Model#:
Quantity:
ACTiSYS Model#:
Quantity:
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Product Sub Total US$
*
:
California Sales Tax (9.25%) for California residents only: US$:
Product Total US$:
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Compatibility
(For tech support reference)
Your application (target device) that ACTiSYS IR adapter will send/receive data to/from?
Brand
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Type
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Model#:
Operating System running on your device & its Version#
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If you use ACTiSYS' RS232-IR adaptor for USB port, whose USB/RS232 convertible cable do you use?
Brand:
Model#:
If order IR100MU/IR100M, your printer model:
, is it all-in-one printer type?
Yes
No
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Contact / Billing Info
First Name
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Last Name
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Email
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Shipping address same as billing address
Yes
No
Company Name
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Billing Address
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City
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State/Province
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Zip Code/Postal Code
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Country
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Phone
*
(include country code):
Fax(include country code):
Shipping address same as billing address
Yes
No
Shipping Address
First Name
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Last Name
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:
Company Name
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:
Shipping Address
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City
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State/Province
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Zip Code/Postal Code
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Country
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Phone(include country code)
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Shipping Info
*Please fill in shipping charges as quoted by ACTiSYS sales representative. (call
510-490-8024
, or email
sales@actisys.com
for price)
*If needed, please contact an ACTiSYS sales representative for details.
Location
*
:
-select-
US Domestic Shipping
International Shipping
US
*
:
UPS Ground Tracking
UPS 3 Days
UPS 2nd Day Air
UPS Next Day Air
FEDEX Overnight AM
FEDEX Overnight PM
FEDEX 2nd Day
FEDEX 3rd Day
DHL
International 4-7 Day Delivery
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:
UPS Expedited
FEDEX Economy
DHL
Delivery Fee US$
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Payment Information
Payment Method
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:
-select-
Credit Card
Wire Transfer
PayPal
Credit Card
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:
-select-
Visa
Master Card
American Express
Credit Card Number
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:
Card Holder Name
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Expiration Date
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:
Security Code
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:
Wire Transfer:
(Please use the bank fee quoted by ACTiSYS sales representative)
Bank fee
*
:
*if using wire transfer, additional bank fee is charged
PayPal:
(Our PayPal ID is: kc@actisys.com)
ID
*
:
Paypal Fee
*
:
(Please use the PayPal fee quoted by ACTiSYS sales representative)
Total Cost:
*For international customers only: Any additional custom duties, import taxes are the customer's responsibility.
*if customer return products within 30days for refund,
deduct 2-way shipping, tax and 20% restocking charge
.
*ACTiSYS products carry a one-year warranty (except IrDA testers).
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