Thin Client Evaluation Request Form

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Thin Client Terminal
Evaluation Unit Request Form

Select the items that apply, and then let us know how to contact you. *

We Would Like to Evaluate the Selected Thin Client Terminal
Send Information on the selected Thin Client Terminal
Have a Salesperson Contact Me

My Need is: *

Immediate
30 Days
60 Days
90 Days

I'm Interested in: *

Type of Host System (Power8, zSeries, Etc.) *

Name *

E-mail Address: *

Company Name *

Address 1 *

Address 2

City: *

State/Province *

Postal / Zip Code *

Country

Telephone Number *

Telephone Extension

Fax Number

Please tell us about your installation, specific requirements, time frame, etc. *

How Did You Hear About This Product?

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