First Name*
 
 
Last Name*
 
 
 
Email*
 
 
 
Company
 
 
Business Phone
 
 
 
Address
 
 
 
City
 
 
State or Province
 
 
 
Zip or Postal Code
 
 
Country:*
 
 
 
Are you a reseller of Socket Mobile products?*
 
Yes
No
 
 
Which Socket Mobile products are you interested in?*
 
 
 
What type of Data are you scanning?*
 
 
 
What host device are you using?*
 
 
 
What is the name and type of software you are using?*
 
 
 
What is the quantity of scanners you are interested in purchasing?*
 
 
 
Estimated purchasing time-frame?*
 
 
 
Please list the name and model of competing scanners you are also considering?*
 
 
 
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