Company name:
First name*:
Last name*:
Street address:
City:
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Country:
Phone:
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If your product is an add-in card, please provide
the following information:


 
Add-in card product name*:
Optional ==> MOKO #:
click here for example
Optional ==> UART # (not all cards have this chip):
click here for example
Optional ==> ASIC # (not all cards have this chip):
click here for example


If your product is an enclosure device (Ether-Serial Link, HQ-ST Link, USB-Serial Link, DataTap, Serial Port Splitter, or SimuCharge USB Tablet Adapter), please provide the following information:
Enclosure product name*:


General information
Purchased from:
Please describe the intended
use for your purchase:
Operating system environment:
Please answer the verification question: 3+11=? 
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