Name:*

E-mail Address:*

Daytime Phone #:

Address:*

City:*

State:*

Zip Code:*


Date Purchased:

Where Purchased:

Home User:
Business User:
If Business User, Name of Business:

Where did you learn about this product?

Is this your first purchase of XSCables products?
Yes No

Product Name:

Part Number:

Serial Number/UPC Code:

Connected Peripherals:

For KVM Switches, please specify Model/Brand:
Mouse
Wireless? No Yes
Keyboard
Wireless? No Yes

For USB to IDE Adaptors:
Size of Hard Drive

For USB to Parallel Printer Converter:
Printer Model