ACTiSYS Corporation -- The wireless connectivity experts!

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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*
City*		State/ Province* Zip Code/Postal Code*
Country*

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

First Name: Last Name:

Shipping Address:

City: State/Province:

Zip Code/Postal Code: Country:

Product Information
List the models you want to buy:

(1) ACTiSYS Model# * :

Quantity * 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 sales@actisys.com
      

Total: US$ * 

International 4-7 day delivery. Please call 510-490-8024, or email sales@actisys.com 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: kc@actisys.com )

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?

Brand*: Type*: Model#:

Operating system running on your Desktop computer/Notebook/Tablet/Smartphones/Handheld:

O.S.&Version#*:

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 , 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!

© 1996-2018 ACTiSYS Corporation, All Rights Reserved

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