Customer/Company/Department: *

Contact Name: *

Email Address: *

Office Phone: *

Cell Phone: *

Current Owner:

Customer/Company/Department: *

Address:

Address 2:

City:

State:
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Zip Code:

Return Shipping Address:

Address: *

Address 2:

City: *

State: *
Select a stateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming
Zip Code: *

County: *

Country: *

Billing Address:

Same as shipping

Certification Required?: *

Radar ($80)Lidar ($130)Sport ($80)NO

Serial Numbers:

Counting Unit:

Antenna 1:

Antenna 2:

Display:

Remote:

Handheld Radar or Lidar:

Other

Other Accessories (Please List):

Detailed description of the problem: *

Warranty Repair*Estimate Required*Repair authorized if under: