Information Request Form

So that we may better serve you, please take a moment to fill out the following information:

[ First Name ]

optional

[ Last Name ]

optional

[ Organization ]

optional

[ E-Mail Address ]

required

[ Telephone Number ]

optional - but very helpful!

[ Fax Number ]

optional - but very helpful!

Optional Information (Not required, but very helpful):

[ Radio Model Interested In ]

[ Frequency Band ]

[ Number of Channels Needed ]

		[ Desired Output Power ]
Yes	No	[ Do you currently use radios? ]

(choose all that apply)
Portables (Handheld Units)
Mobiles (Mounted in Vehicles)
Base Stations (Mounted in Buildings)
Repeaters

[ Type of Equipment Needed ]

(choose all that apply)
Contracting
Education
Industrial
Marine
Aviation
Government
Farming

[ What is the equipment going to be used for? ]

(choose one)
Within Building
Less Than a Mile
1-2 Miles
2-5 Miles
5+ Miles

[ Maximum Coverage/Range Desired ]

(choose all that apply) Open Area Light forest Heavy forest Large Hills Lightly Pop. Rural Residential Small City Medium City Large City Avionics Use Maritime Use	[ Surroundings/Environment ]
(choose one) Less than $100 $100- $200 $201-$400 $401-$600 $601-$800 More than $800 Any	[ What is Your Price Range (per unit): ]

(choose one)
Within a week
Within a month
2-6 months
Within a year
Don't know yet

[ How soon do you intend to purchase your equipment? ]

(choose all that apply)
Visa
MasterCard
American Express
Discover
Check
COD
Lease the Equipment

[ How would you like to handle any possible transactions? ]

[ How did you find our site? ]

Additional Information/Comments: