Product Registration Form

Please provide the following information

First Name*
Last Name*
Title
Organization*
Street Address*
Address (cont.)
City*
State/Province*
Zip/Postal Code*
Country*
Work Phone*
FAX
E-mail*
URL

Which of the following products did you purchase?

		QTY		QTY		QTY		QTY
i-LiNE Load Switches	i-ON		i-ON-D		i-ON-Dlv		i-ON-F
i-LiNE Scene Switches	i-ON-MB		i-ON-Dsl		i-ON-sl
i-LiNE Network Modules	i-PoWER-M1		i-PoWER-M4		i-PoWER-M4t		i-PoWER-M1p
	i-PoWER-M4tp		i-PoWER-XT
i-LiNE Connection Modules	i-PoRT-C1		i-PoRT-C4		i-PoRT-C1p		i-PoRT-C4p
	i-PoRT-IRs		i-PoRT-IRf		i-PoRT-COM
i-LiNE Enclosures	i-BoX-1		i-BoX-2
HMB Products	HMB

Please provide the following additional information

Place of Purchase*
Purchased From*
Date of Purchase*