Explosive Detection Inquiry Form - Quote Request Form

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"Required" Fields" Please complete or we will be unable to process your quote request.  Thanks...

Your Name: Only 3 (Required Field)

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Your e-mail address:   (Required Field) Phone (Required Field)  Work Cell Home Other

Type of system needed: Explosive Tester Electronic Type Portable Electronic Desktop Type Scanner Conveyorized type X-Ray Scanner Non-conveyorized X-Ray Scanner Other type not listed Items you want to screen for: -Select One- Mail and Small Parcels Narcotics and Drugs Handguns and weapons Explosive Materials Other Illegal weapons Other Contraband (not listed) Non-destructive testing (food, parts) Briefcases, purses, backpacks, etc Baggage (airport) Air Cargo Other Items not listed (For multiple selections Hold down  Ctrl-key and click on selection) Type of facility unit will be used at: -Select One- Airport Seaport Public Facility other than Airport/Seaport Government Facility Courthouse Private Business Other Facility not listed here Purpose for purchasing: -Select One- To resell Security Products Dealer End user of product To export Your Business Entity Description: -Select One- Government Agency in USA Government Agency (Outside USA) Private Company in USA Private Company (Outside USA) Individual (USA) Individual (Outside USA) Other Entity not listed above -please list School /District Courthouse Airport Seaport Crusie Company Corporate Business Entity Small business in USA List Entity Type if not listed above Check off the types of items you want to screen for:  Narcotics-Cocaine, Heroin, PCP, THC, Methamphetamine, Marijuana, Ecstasy and others Explosive substances like Dynamite, HMX, C-4, RDX, PETN, TNT, Semtex, NG and others Other Contraband not listed here (list below) Non-Destructive Testing of (food products, Mfg. Parts, etc) Chemical Detection- GA, GB, GD, VX, HD, Lewisite (L), pepper spray, mace Other Item not listed above -Please list here Intended place of equipment use: -Select One- USA Outside of the USA Budget (approximate): Time Frame for purchasing: -Select One- AS SOON AS POSSIBLE Within a few weeks Within 1 Month Within 2-3 Months Within 6 Months Upon approval NO SURE WHEN...JUST SHOPPING Sometime this year Please send Quote by: By Fax (email file attachment) Please follow up withA phone call No phone call E-mail Reply Both email/phone call Your Company Name: Address City StateZip   Fax

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Special Note: All information on this form is kept totally confidential and is not distributed to anyone. You will not be spammed and we will not give your e-mail address to others! Some restrictions may apply to the export and or resale of these products.

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