Its A Wonderful Day Here At X86Systems, Inc.

Please use the form below to fill out your Secured
Credit Card or Personal Check order.

Ordering electronically is easy and secure.
Step 1: Select the product you like.
Step 2: Enter personal information and credit card information.
Step 3: Submit the purchase.
Step 4: You will get a confirmation via e-mail.

Or, you can print out the Product Order Form and fax it to us.

BILLING ADDRESS

Name(First & Last)(Required):

Address:

City:

State:

Zip Code:

Country

Phone(Required):

E-Mail(Required):

Fax:

Item Description(Required):

ITEM #(If Applicable):

Full Amount including S&H(Required):

Shipping (Via UPS Ground / USPS Priority Mail) Handling And Insurance

For Memory Products Please add $9.00

For CPU Products Please add $12.00

For CD-Recorders Please add $19.00

For International Orders Please E-Mail or Call

Include Cost + Shipping Please.(Include decimal point and 2 digits for cents)

Enter special/additional info:

SHIPPING ADDRESS (If shipping is different from above please fill in. If it is the same, skip.)

Name (First & Last)

Company

Address

City

State

Zip Code

For Any Questions Please e-mail us at x86@gate.net

Tel:	(561) 792-0051
Fax:	(561) 792-0056