<p> Infiltec Seismometers FAX ORDER FORM http://www.infiltec.com/seismo</p><p>If you want to pay by credit card or Paypal, please print out this form, fill it out, and fax it to David Saum, Infiltec, FAX: 703-671-9350, PHONE 703-820-7696. You do not have to include a cover page with your fax. For more product information, see http://www.infiltec.com/seismo</p><p>We will inform you when your order is ready to ship, and then you should reconfirm that you want the shipment. we When we get your confirmation, we will ship and bill your credit card, or you can make a payment to Paypal before we ship.</p><p>YOUR SEISMOMETER ORDER:</p><p>Quantity Product Price Subtotal LONG PERIOD (1.0 Hz low pass, designed for long period sensors like Lehman's) ______QM-1.0-3704 assembled/tested pcb, coil, diecast enclosure, 370-4 magnet $144 ______QM-1.0 assembled/tested pcb, 9k ohm coil, 10' ft cable, no enclosure $99 ______370-4 alnico horseshoe magnet (22lb/9.97kg pull) fits around coil $25 ______</p><p>SHORT PERIOD (4.5 Hz low pass, designed for L-15B Mark Products 4.5 Hz Geophone) ______QM-4.5-L15B assembled/tested pcb, diecast enclosure, 10' cable, L-15B geophone $159 ______QM-4.5 assembled/tested pcb, 10 ft serial cable, no enclosure $99 ______L-15B Mark Products 4.5 Hz Geophone (used but tested working) $40 ______</p><p>STRONG MOTION (4.5 Hz low pass, designed for single axis ADXL103 accelerometer) ______QM-4.5-ADXL103 assembled/tested pcb, enclosure, 10' ft cable, mounted ADXL103 $149 ______QM-4.5 assembled/tested pcb, 10 ft serial cable $99 ______QM-ADXL103 accelerometer chip and components mounted on DIP8 board for QM-4.5 $30 ______L-15B Mark Products 4.5 Hz Geophone (used), works with QM-4.5-ADXL103 $40 ______</p><p>OPTIONAL SERIAL EXTENSION CABLES FOR REMOTE INSTALLATIONS ______Extension DB9(M/F) Cable (10 ft) $10 ______Extension DB9(M/F) Cable (25 ft) $20 ______Extension DB9(M/F) Cable (50 ft) $30 ______Extension DB9(M/F) Cable (100 ft) $50 ______</p><p>TOTALS Product Total ______5% sales tax for VA customers ______Shipping within US (USPS Priority Mail $5) ______Shipping outside US (type ______) * ______</p><p>Total ______</p><p>* NOTE: to determine shipping outside the US, we recommend that you consult the USPS web page http://ircalc.usps.gov and select your country, select "package" and select 2 lb and 0 oz (1 kg) weight for each seismometer. Our preferred overseas shipper is USPS Global Priority Mail, but we will try to assist you other shipping options. If you prefer, we may be able to use shippers like DHL, USP and Federal Express if you can find out how much it will cost for a small box (less than 1 ft3) shipped from USA zip code 22041 and weighing about 2 lb. (1 kg) per seismometer. Note that for international orders, you are responsible for import duty and taxes. </p><p>YOUR SHIPPING ADDRESS: NAME: COMPANY: STREET1: STREET2: CITY: STATE: POSTAL CODE: COUNTRY: PHONE:</p><p>YOUR CREDIT CARD: TYPE: (VISA) (MASTERCARD) (AMEX) CARD NUMBER: ISSUING BANK: NAME ON CARD: CARD EXPIRES: SECURITY CODE: SIGNATURE: TODAYS DATE:</p><p>We also accept Paypal to [email protected]</p><p>AVAILABILITY: Orders may require 2-4 weeks to build and test. We will not bill you until we ship. </p><p>OUR CONTACT INFORMATION: David Saum, Infiltec PO Box 8202 (physical address: 5613 Leesburg Pike, Suite 53) Falls Church, VA 22041-8202, USA phone: 703-820-7696, fax: 703-671-9350, email: [email protected]</p><p>______FAX COMPLETED FORM TO 703-671-9350 ______November 9, 2005 version</p>