Product/Service Inquire

First Name/Last Name *

Company *

Upload a PDF Form for both
Service/Repair and Rental Applications.

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

What kind of service in needed? *

Product pruchase

Product Rental

Product Repair

Product Delivery/PICK-UP DATE +

Which Product 🛈

	Kenwood		Motorola		GlobalStar		Icom
Product

How Many

Which Product/Continued 🛈

	Kenwood		Motorola		GlobalStar		Icom
Product

How Many

Which Product/Continued 🛈

	Kenwood		Motorola		GlobalStar		Icom
Product

How Many

Please enter product details not listed above.

RENTAL SERVICES

If RENTING what is the Job's Name?

What is the Job's Location?

Which PRODUCT is needed?

Product Name

If inquiring about RENTAL,
when is the START date? +

When is the
END date? +

If needing REPAIR SERVICES, please select below.

	Model	Serial / IMEI
Item Needing Repair	Model	Serial / IMEI

Estimate

Warranty

Contact

Outside

	Battery	Belt-Clip	Antenna	Speaker Mic	Other
Part	Battery	Belt-Clip	Antenna	Speaker Mic	Other

If inquiring about Repair, when is the START date? +

When is the END date? +

TROUBLE REPORTED, please describe below the details on the repair that's needed.