XESS Product Order Form

Complete this form to order AIS products. Products are normally shipped within two business days.

Shipping and handling charges are additional and vary depending upon your location. Orders in the USA are shipped UPS ground, by default. Orders outside the USA are shipped using a variety of methods. Please indicate your requirements below in Special Instructions.

Quantity:

Quantity:

Quantity:

Media Type:

Ship to: 

              Name: 
 Firm/Organization: 
           Address: 
              City:  State/Prov: 
        ZIP/Postal:  Country: 
         Telephone: 
            E-mail: 


      Payment Type: 
Credit Card Number:  Expires: 

      Name on Card:

Billing Address, if different (for credit approved organizations only):

    Purchase Order: 

              Name: 
 Firm/Organization: 
           Address: 
              City:  State/Prov: 
        ZIP/Postal:  Country: 
        Fax Number:

Special Instructions:

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Applied Information Systems, Inc.
121 South Estes Drive
Chapel Hill, NC 27514 USA
1-919-942-7801
1-800-334-5510
1-919-942-0793 FAX
info@appliedinfosys.biz.