Gordon Instruments On-site Demonstration Request Form

Your Name
Dr. Mr. Ms.

Your Position

Your Department

Your Hospital, Institution, or Company

Your Address

Your E-mail Address

Your Phone Number

Your Fax Number

Please call me; I am interested in scheduling a free, on-site demonstration of the following products. Check all that apply:

TeleMatePlus Radiographic Display Systems

Video Lectern Multimedia Presentation Systems

If I find the product acceptable, I expect a purchasing decision will be made:
Immediately
1-3 months
3-6 months
6-12 months
This demonstration is requested only for budgeting and planning purposes.

Please use the space below to

• list the best times to reach you by phone
• how the equipment will be used, for example, the type of meeting
• include any additional information and any questions you might have regarding your specific needs.

If you make a mistake, you may and begin again.

When you have finished,