Quatech Data Acquisition and Communication hardware & Software

*First Name:
*Last Name:
Title:
*Company:
*Street Address:
*City:
State/Province:	(Please use postal abbreviation)
*Zip/Postal Code:
*Country:

*E-Mail Address:
Company Website:
Phone: 999-999-9999*
Fax: 999-999-9999
How would you like to be contacted?	Phone E-mail Fax

For which Quatech product(s) would you like a quote?

Item #: (example: QSP-100)
Quantity:

What is your purchasing time frame?

immediate need two weeks one month three months
six months more than 6 months

How would you classify your business?

OEM VAR Systems Integrator Other

If you have any specific delivery date requirements, or any questions about a product's features/functions, please indicate them in the field below so that we will be better able to accurately prepare your quote.

Would you like to receive special offers and notification of new product releases via e-mail?

Yes No

In which of Quatech's product lines are you interested?

Data Communication Products Data Acquisition Products Both

If you have trouble submitting the form, you can print this page and fax it to us at 877.FAX.IECI or email your name, address, and phone number and we will get back to you as soon as possible.


	USA Office: Tel: 1-877-902-2979 Fax: 1-877-FAX-IECI Pacific Time Zone
	Tel:1-425-223-4311 Fax: 1-425-223-4303 Pacific Time Zone
		P.O. Box 1280. Street Address: 145 Tyee Drive, Point Roberts, WA 98281
		Sales inquiries to: sales at interworldusa.com Support & Service: support at interworldusa.com
	*Western Canada:* - Vancouver, B.C. Tel: 1-(604) 925-6150 Fax: 1-(604) 925-6170 Toll Free:1-(800) 663-6001
		2454 Haywood Ave, West Vancouver, B.C. V7V 1Y1
	*Eastern Canada:* - Markham, Ontario Tel: 1-(905) 513-7027 Fax: 1-(905) 513-7029 Toll Free:1-(800) 465-0164
		3555 14th Ave, Unit 12, Markham, Ontario L3R 0H5
	Sales inquiries to: sales at interworld.ca Support & Service: support at interworld.ca