Name:
Company:
Phone number:	Extension
E-mail
Fax number:	Customer application requirements
Part number, Model #	Or number of channels
Range: Transmitter - Receiver	In Miles, Km / Meter, feet:  Please specify
If Obstruction:	Threes, Building, Wall, What Material?
Transmitter with Solar power	When  power is not available
Is Monitoring or alarm required	HI LO Alarm, Status, Please specify
REQUEST: Brief description control or operation,  number of circuits
Type of application	Pump control, gate, lighting etc.

Please note that we DO NOT share your information with any other party

    Thank You.