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 UPDATED: 12/26/06
 
TECHNICAL SUPPORT - EVALUATION FORM

Reseller/OEM Only:
Please complete the form to request for a 30-days product evaluation. Our sales department will review your request and will email/fax your confirmation along with an evaluation agreement. If you are not a QVS Reseller and still want to do product evaluation, reseller permit will be required. Please allow one to three days for processing.

Customer Information Product Information

Account No. (For QVS Reseller):

Company Name:

Name:*

E-mail Address:*

Account/Sales Representative:

Daytime Telephone:*

Address:

City:

State/Province:

Postal Code:

Country:

How did you hear about QVS?

Product Name:

Part Number:

Serial Number/UPC Code:

Quote for Quantity of:

Operation System:


Product Application:


Where did you learn about this product?

Is this your first QVS products?
Yes No

Your primary business classification?

Payment Terms
MC VISA AMEX Charge to Account (QVS Reseller Only)
Card Number:

Expiration Date:

Billing Address: (if different from above)
Name:

Address:

**Note: You will be billed only at the end of your evaluation period, unless the product is returned or by special agreement.
For Customers Outside the United States & Canada
Shipping Methods: FEDEX UPS DHL Airborne Express
Shipping Account No.

Shipping Address:

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