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-- How To Order --                

You can purchase ACTiSYS products in several ways. You may call us directly at 1-510-490-8024, fax in your order at 1-510-623-7268 by using this printable form, or online purchasing below.

 (The fields with * mark and bold font are the required information)

How did you hear about us?

Sales Person

General Information                        Today's Date* :

First Name*

Last Name*
Your e-mail address*
Your telephone* (if outside USA, please include country code)

Your Fax Number (if outside USA, please include country code)

Your Company Name*
Street Address*

    State/ Province*                          Zip Code/Postal Code*

Ship to: (if different than above (Billing/Invoice address))



Product Information
List the models you want to buy: 
(1) ACTiSYS Model# * :       

* Price US$/ea* Sub Total1 US$*

If order ACT-IRxxxE, please enter ACT adapter as a separate entry with the dollar zero and specify country type

                                                                      Product Sub Total US$ *

        California Sales Tax (9.25%) for California residents only :   US$ 

                                                                             Product Total US$
Shipping Information
* Please only choose one.
* Please fill in shipping charges as quoted by ACTiSYS sales representative. 
* If needed, please contact an ACTiSYS sales representative for details.
US: Domestic Shipping Cost: please call 510-490-8024, or email

Total: US$ *
International 4-7 day delivery. Please call 510-490-8024, or email for price                          Total: US$ *
Payment Information (if using wire transfer, additional bank fee is charged):
Credit Card :              
Credit Card Number : 
CardHolder Name :    Expiration Date :
Security Code :         
Wire Transfer: bank fee: (Please use the bank fee quoted by ACTiSYS sales representative)

PayPal: ID:          (Our PayPal ID is: )

             charges: (Please use the PayPal fee quoted by ACTiSYS sales representative)

*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).

Compatibility: For tech support reference*
Your application (target device) that ACTiSYS IR adapter will send/receive data to/from?
Operating system running on your Desktop computer/Notebook/Tablet/Smartphones/Handheld:

If you use ACTiSYS' RS232-IR adaptor for USB port, whose USB/RS232 convertible cable do you use?

If order IR100MU/IR100M:Your printer model , All-in-one printer type? Yes No
             ***** Thank you for taking the time in completing this form *****


ACTiSYS CORP. will never release your personal information to any third party.
(Privacy Policy). We look forward to serving you very soon!


ACTiSYS CORP.  | 921 Corporate Way| Fremont, CA 94539 | Tel: +1-510-490-8024 |  Fax: +1-510- 623-7268 |

© 1996-2018 ACTiSYS Corporation, All Rights Reserved

Member of Infrared Data Association
® (IrDA) Since Its Founding Day!