Customer/Company/Department: *

Contact Name: *

Email Address: *

Office Phone: *

Cell Phone: *

Current Owner:

Customer/Company/Department: *

Address:

Address 2:

City:

State:
Select a state Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Zip Code:

Return Shipping Address:

Address: *

Address 2:

City: *

State: *
Select a state Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
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: