Retail Trial Request

First Name

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Last Name

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Phone

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Job Title

Organization

Address Line 1

Address Line 2

City

State

Zip Code

Country

Industry

Items Agreed for Trial

Agreed Trial Length

Camera Model One

Camera Model Two

Camera Model Three

Quantity of Cameras

Docking Station One

Docking Station Two

Quantity of Docking Stations

Mounting Option One

Mounting Option Two

Mounting Option Three

Quantity of Mounts

Additional Hardware

Quantity of Hardware

Comments

Agreed Deployment Type

If trials are not returned by the agreed end date, Reveal Media reserves the right to send an invoice for the goods shipped. By checking this box you agree to the Reveal Trial Evaluation Terms & Conditions & DEMS 360 Service Evaluation Terms (applicable in the case of a Cloud hosted trial).

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