Infiltec Seismometers FAX ORDER FORM http://www.infiltec.com/seismo If you want to pay by credit card or Paypal, please print out this form, fill it out, and fax it to Infiltec, FAX: (540) 932-3025, PHONE (540) 943-2776. You do not have to include a cover page with your fax. For more product information, see http://www.infiltec.com/seismo We will inform you when your order is ready to ship, and then you should reconfirm that you want the shipment. When we get your confirmation, we will ship and bill your credit card, or you can make a payment to Paypal before we ship. YOUR ACCELEROMETER SEISMOMETER ORDER: Quantity Product Price Cost COMPLETE SINGLE AXIS DIGITAL ACCELEROMETER with internal vertical ADXL203 sensor and software Includes: metal case, 15' DB9 serial cable, software CD, USB adapter, free shipping in USA ________ QM-ADXL203V-20HZ for horizontal accelerometer system for mG monitoring - 0.01-20.0 Hz bandwidth $345 ________ ________ QM-ADXL203H-20HZ for vertical accelerometer system for mG monitoring - 0.01-20.0 Hz bandwidth $345 ________ OPTIONAL CABLES (extra weight may require added shipping cost) ________ CABLE USB-SERIAL USB to Serial DB9 Adapter Cable tested for QM-4.5LV power and data $25 ________ ________ CABLE-02712 Serial RS232 Extension DB9(M/F) Cable (15 ft) $10 ________ ________ CABLE-09452 Serial RS232 Extension DB9(M/F) Cable (25 ft) $20 ________ ________ CABLE-09453 Serial RS232 Extension DB9(M/F) Cable (50 ft) $30 ________ ________ CABLE-17612 Serial RS232 Extension DB9(M/F) Cable (100 ft $50 ________ ________ CABLE-CAT5E-100M Serial RS232 (4Pin) Outdoor Rated Extension DB9(M/F) Cable (100 meters) $150 ________ NEW ITEM ________ CABLE-CAT5E-XXXM custom QM cables made from CAT5E Outdoor cable over 50 meters DB9(M/F) available ( m) $1.5/m ________ NEW ITEM SHIPPING ________ Within USA - US Postal System (USPS) Priority mail with insurance for one seismometer $INCLUDED ________ Outside USA - USPS Air Mail with NO TRACKING & NO INSURANCE for one seismometer $65 ________ ________ Outside USA - UPS or FEDEX with TRACKING AND INSURANCE for one seismometer $160 ________ TOTALS Product SubTotal ________ 5.3% sales tax (ONLY for VA customers) ________ TOTAL ________ * NOTE: Shipping for one seismometer is a small box about 1 kilo (2.2 lb) in weight. Also note that for international orders, you are responsible for any import duty and taxes. US Postal System (USPS) air mail overseas takes 5-10 days to reach your destination, but the customs processing in your country can take days or weeks. USPS air mail DOES NOT provide tracking or insurance after the package leaves the USA. In our experience, USPS air mail can be slow but we have never lost a package. UPS and FEDEX are much more expensive but they expedite customs processing so that overseas packages arrive within about 5 days and have tracking and insurance. YOUR SHIPPING ADDRESS: NAME: COMPANY: STREET1: STREET2: CITY: STATE: POSTAL CODE: COUNTRY: PHONE: YOUR CREDIT CARD: TYPE: (VISA) (MASTERCARD) (AMEX) CARD NUMBER: ISSUING BANK: NAME ON CARD: CARD EXPIRES: SECURITY CODE: SIGNATURE: TODAYS DATE: We also accept Paypal to infiltec@gmail.com or bank wire transfer. AVAILABILITY: Orders may require 2-4 weeks to build and test. We will not bill you until we ship. OUR CONTACT INFORMATION: Infiltec 108 South Delphine Avenue Waynesboro, VA 22980, USA phone: (540) 943-2776, fax: (540) 932-3025, email: Infiltec@gmail.com __________ EMAIL infiltec@gmail.com OR FAX COMPLETED FORM TO (540) 932-3025 _______ December 12 2015 version