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Company name:

*E-mail address:

*Mailing address:

*City, State, Zip:

*Phone Number: FAX Number:

Sales Rep Code: 

*Demo to Download:
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to extract the install program.


N/A Healthcare Commercial/Industrial Government Public Safety 
Communications Application Development Personal
Company (Number of employees):

N/A 0-99  100-499 500+ 
Internet Access:

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Network OS Used:

N/A Windows 2003 Windows 2000 Windows NT Windows 9x Novell Other 
Desktop OS Used:

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How did you find us: 
N/A Current InfoRad customer Wireless Carrier Web search E-mail Post Card 
Internet Ad Print Ad or story Colleague Friend Family Yellow Pages Other 
What type of wireless device do you use:
N/A One-way pager Two-way pager Phone PDA Blackberry Other 
Who is your wireless provider:
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T-Mobile SPOK Verizon Other Paging Carrier Other Cellular/PCS Carrier
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