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Customer Information Update Form

Dec. 19, 2007

Dear Customer,
In order to make sure the records in our computer are up to date, we would appreciate it, if you could take some time and fill in or update the following information.

If you would prefer to fax the form to us you may download a Microsoft Word Document here and fax it to 770-435-0402

Customer Number
Company or City/Municipality
Street Address
City
State
Zip/Postal code
Contact Person who can authorize repair work and issue PO numbers
Phone
Cell Phone
Fax
Email Address
Secondary Contact Person

Do you require purchase order numbers?

What color video cable do you use?

Green
Black
Blue
Light Green
Orange
Red

What type of termination do you use?

12 Pin Swivel
8 Pin Cobra
5X4 Pin
8 Pin Cues

Do you want your return shipments insured?

Yes
No
Camera Serial Numbers
Crawler Serial Numbers
Please enter the text shown in the image below. Reload Image

Coming soon, you will be able to track your own shipments from us on Quantum View Manage, but we must have your email address

Thank you for your cooperation and have a great day!