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Online Order Form
Dealer Information
Dealer Name
P.O. Number
Requested Ship Date
Dealer Address
Salesperson Name
Saleperson email
Salesperson Phone
Customer Information
Customer Name
Customer Site Name
Site Address
Contact Name
Contact Email
Contact Phone
Customer Time Zone
EST
CST
MST
PST
Daylight Savings
Ship To Information
Dealer
Customer
Other:
.
.
.
Service Dealer Information
Same As Dealer Information
Dealer Name
Service Contact Number
Service Contact Email
Order Information
Quantum Model Number
QTY
AC
Voltage
Charging
Type
Multi
Voltage
24V Batt
AH
36V Batt
AH
48V Batt
AH
80V Batt
AH
Connector
Type
Cable
Length
---
208VAC
380VAC
480VAC
600VAC
---
Conventional
Opportunity
Fast
---
Yes
No
---
8 ft. (Q4/Q6)
10 ft. (Q12)
Other (Additional Cost)
---
208VAC
380VAC
480VAC
600VAC
---
Conventional
Opportunity
Fast
---
Yes
No
---
8 ft. (Q4/Q6)
10 ft. (Q12)
Other (Additional Cost)
---
208VAC
380VAC
480VAC
600VAC
---
Conventional
Opportunity
Fast
---
Yes
No
---
8 ft. (Q4/Q6)
10 ft. (Q12)
Other (Additional Cost)
---
208VAC
380VAC
480VAC
600VAC
---
Conventional
Opportunity
Fast
---
Yes
No
---
8 ft. (Q4/Q6)
10 ft. (Q12)
Other (Additional Cost)
---
208VAC
380VAC
480VAC
600VAC
---
Conventional
Opportunity
Fast
---
Yes
No
---
8 ft. (Q4/Q6)
10 ft. (Q12)
Other (Additional Cost)
Customized Order
Please Provide Your Charging Profile
Default
Custom
Finish Charge Days
MON
TUE
WED
THU
FRI
SAT
SUN
Finish window start time
---
0:01
0:15
0:30
0:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15
3:30
3:45
4:00
4:15
4:30
4:45
5:00
5:15
5:30
5:45
6:00
6:15
6:30
6:45
7:00
7:15
7:30
7:45
8:00
8:15
8:30
8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
13:00
13:15
13:30
13:45
14:00
14:15
14:30
14:45
15:00
15:15
15:30
15:45
16:00
16:15
16:30
16:45
17:00
17:15
17:30
17:45
18:00
18:15
18:30
18:45
19:00
19:15
19:30
19:45
20:00
20:15
20:30
20:45
21:00
21:15
21:30
21:45
22:00
22:15
22:30
22:45
23:00
23:15
23:30
23:45
Duration
---
0:01
0:15
0:30
0:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15
3:30
3:45
4:00
4:15
4:30
4:45
5:00
5:15
5:30
5:45
6:00
6:15
6:30
6:45
7:00
7:15
7:30
7:45
8:00
8:15
8:30
8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
13:00
13:15
13:30
13:45
14:00
14:15
14:30
14:45
15:00
15:15
15:30
15:45
16:00
16:15
16:30
16:45
17:00
17:15
17:30
17:45
18:00
18:15
18:30
18:45
19:00
19:15
19:30
19:45
20:00
20:15
20:30
20:45
21:00
21:15
21:30
21:45
22:00
22:15
22:30
22:45
23:00
23:15
23:30
23:45
EQ Charge Days
MON
TUE
WED
THU
FRI
SAT
SUN
EQ window start time
---
0:01
0:15
0:30
0:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15
3:30
3:45
4:00
4:15
4:30
4:45
5:00
5:15
5:30
5:45
6:00
6:15
6:30
6:45
7:00
7:15
7:30
7:45
8:00
8:15
8:30
8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
13:00
13:15
13:30
13:45
14:00
14:15
14:30
14:45
15:00
15:15
15:30
15:45
16:00
16:15
16:30
16:45
17:00
17:15
17:30
17:45
18:00
18:15
18:30
18:45
19:00
19:15
19:30
19:45
20:00
20:15
20:30
20:45
21:00
21:15
21:30
21:45
22:00
22:15
22:30
22:45
23:00
23:15
23:30
23:45
Duration
---
0:01
0:15
0:30
0:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15
3:30
3:45
4:00
4:15
4:30
4:45
5:00
5:15
5:30
5:45
6:00
6:15
6:30
6:45
7:00
7:15
7:30
7:45
8:00
8:15
8:30
8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
13:00
13:15
13:30
13:45
14:00
14:15
14:30
14:45
15:00
15:15
15:30
15:45
16:00
16:15
16:30
16:45
17:00
17:15
17:30
17:45
18:00
18:15
18:30
18:45
19:00
19:15
19:30
19:45
20:00
20:15
20:30
20:45
21:00
21:15
21:30
21:45
22:00
22:15
22:30
22:45
23:00
23:15
23:30
23:45
EQ frequency in days*
---
0
5
6
7
8
9
* this setting will override the above schedule
Finish frequency in days*
---
0
5
6
7
8
9
* this setting will override the above schedule
* Marked Entries will be logged in ACTview
BATTview Model
QTY
Batt
AH
Batt
Voltage
Charging
Type
---
850-BTV-MB BATTview Mobile (Pre-Sale Tool)
850-BTV-PRO BATTview Pro - Combo Probe
850-BTV-PRO+4 BATTview Pro - Combo Probe with 5 Year Warranty
850-BTV-PRO-AIM BATTview Pro - Combo Probe - ACTintelligent Managed (5 Year Subscription Included)
850-BTV-PRO-AIM+4 BATTview Pro - Combo Probe - ACTintelligent Managed (5 Year Subscription Included & with 5 Year Warranty)
---
24V
36V
48V
80V
---
Conventional
Opportunity
Fast
---
850-BTV-MB BATTview Mobile (Pre-Sale Tool)
850-BTV-PRO BATTview Pro - Combo Probe
850-BTV-PRO+4 BATTview Pro - Combo Probe with 5 Year Warranty
850-BTV-PRO-AIM BATTview Pro - Combo Probe - ACTintelligent Managed (5 Year Subscription Included)
850-BTV-PRO-AIM+4 BATTview Pro - Combo Probe - ACTintelligent Managed (5 Year Subscription Included & with 5 Year Warranty)
---
24V
36V
48V
80V
---
Conventional
Opportunity
Fast
---
850-BTV-MB BATTview Mobile (Pre-Sale Tool)
850-BTV-PRO BATTview Pro - Combo Probe
850-BTV-PRO+4 BATTview Pro - Combo Probe with 5 Year Warranty
850-BTV-PRO-AIM BATTview Pro - Combo Probe - ACTintelligent Managed (5 Year Subscription Included)
850-BTV-PRO-AIM+4 BATTview Pro - Combo Probe - ACTintelligent Managed (5 Year Subscription Included & with 5 Year Warranty)
---
24V
36V
48V
80V
---
Conventional
Opportunity
Fast
Battery type:
---
Lead acid
Gel
Li-ion
Cold Storage Application?
---
Yes
No
How will the chargers be mounted?
---
ACT Wall Mount
ACT Floor Span
Floor Mounted
Changing system
Custom stands
Will the chargers be stacked?
---
Yes
No
Will the charger be used on a changing system?
---
Yes
No
Will all batteries have BATTview installed?
---
Yes
No
Customized Order
Please Provide Your Charging Profile
Default
Custom
Finish Charge Days
MON
TUE
WED
THU
FRI
SAT
SUN
Finish window start time
---
0:01
0:15
0:30
0:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15
3:30
3:45
4:00
4:15
4:30
4:45
5:00
5:15
5:30
5:45
6:00
6:15
6:30
6:45
7:00
7:15
7:30
7:45
8:00
8:15
8:30
8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
13:00
13:15
13:30
13:45
14:00
14:15
14:30
14:45
15:00
15:15
15:30
15:45
16:00
16:15
16:30
16:45
17:00
17:15
17:30
17:45
18:00
18:15
18:30
18:45
19:00
19:15
19:30
19:45
20:00
20:15
20:30
20:45
21:00
21:15
21:30
21:45
22:00
22:15
22:30
22:45
23:00
23:15
23:30
23:45
Duration
---
0:01
0:15
0:30
0:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15
3:30
3:45
4:00
4:15
4:30
4:45
5:00
5:15
5:30
5:45
6:00
6:15
6:30
6:45
7:00
7:15
7:30
7:45
8:00
8:15
8:30
8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
13:00
13:15
13:30
13:45
14:00
14:15
14:30
14:45
15:00
15:15
15:30
15:45
16:00
16:15
16:30
16:45
17:00
17:15
17:30
17:45
18:00
18:15
18:30
18:45
19:00
19:15
19:30
19:45
20:00
20:15
20:30
20:45
21:00
21:15
21:30
21:45
22:00
22:15
22:30
22:45
23:00
23:15
23:30
23:45
EQ Charge Days
MON
TUE
WED
THU
FRI
SAT
SUN
EQ window start time
---
0:01
0:15
0:30
0:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15
3:30
3:45
4:00
4:15
4:30
4:45
5:00
5:15
5:30
5:45
6:00
6:15
6:30
6:45
7:00
7:15
7:30
7:45
8:00
8:15
8:30
8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
13:00
13:15
13:30
13:45
14:00
14:15
14:30
14:45
15:00
15:15
15:30
15:45
16:00
16:15
16:30
16:45
17:00
17:15
17:30
17:45
18:00
18:15
18:30
18:45
19:00
19:15
19:30
19:45
20:00
20:15
20:30
20:45
21:00
21:15
21:30
21:45
22:00
22:15
22:30
22:45
23:00
23:15
23:30
23:45
Duration
---
0:01
0:15
0:30
0:45
1:00
1:15
1:30
1:45
2:00
2:15
2:30
2:45
3:00
3:15
3:30
3:45
4:00
4:15
4:30
4:45
5:00
5:15
5:30
5:45
6:00
6:15
6:30
6:45
7:00
7:15
7:30
7:45
8:00
8:15
8:30
8:45
9:00
9:15
9:30
9:45
10:00
10:15
10:30
10:45
11:00
11:15
11:30
11:45
12:00
12:15
12:30
12:45
13:00
13:15
13:30
13:45
14:00
14:15
14:30
14:45
15:00
15:15
15:30
15:45
16:00
16:15
16:30
16:45
17:00
17:15
17:30
17:45
18:00
18:15
18:30
18:45
19:00
19:15
19:30
19:45
20:00
20:15
20:30
20:45
21:00
21:15
21:30
21:45
22:00
22:15
22:30
22:45
23:00
23:15
23:30
23:45
EQ frequency in days*
---
0
5
6
7
8
9
* this setting will override the above schedule
Finish frequency in days*
---
0
5
6
7
8
9
* this setting will override the above schedule
* Marked Entries will be logged in ACTview
ACTintelligent services?
---
YES
NO
Purchase Orders will not be accepted without facility plan view drawings or ACT personnel walk through and approval from ACT Application Engineering Team.
Facility Information
Total covered area in sq-ft (approximation)
Total number of connected devices
Quantum Chargers
BATTviews
Cell phone coverage available inside the facility?
---
YES
NO
Number of Repeaters
Gateway needed
---
850-AVGT-25 Installs of less than 25 units
850-AVGT-1 Installs of up to 100 units
850-AVGT-2 Installs of up to 200 units
850-AGVT-3 Installs of up to 300 units
Extra Antenna Needed?
---
YES
NO
Operation / Work Schedule
Day
Shift
Start Time
Shift
End Time
Shift
Start Time
Shift
End Time
Shift
Start Time
Shift
End Time
---
Y
N
MON
---
Y
N
TUE
---
Y
N
WED
---
Y
N
THU
---
Y
N
FRI
---
Y
N
SAT
---
Y
N
SUN
Alerts Settings
Please include Email address to receive site alerts (users must be registered on Act-view.com)
Name
Email
Name
Email
Name
Email
Special Comments / Ship-in Commissions:
Send the completed PDF to this recipient (Optional):
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