ATLANTIC SIGNAL
21 DAY FIELD TEST FORM
for Domestic Law Enforcement and Military Clients

This electronic agreement will provide your Department/Organization with an MH Series Tactical Headset System built for the portable radio system you specify within the form below. There is no charge for the field test unit as long as it is returned within the 21 day time frame specified on the shipping invoice that will be enclosed with the MH Series Headset System when shipped. Failure to return the unit within the agreed to 21 day field trial period, may result in an invoice being issued to your Department/Organization and/or you personally.

The information you provide below is considered private and will never be forwarded, shared or sold to any other party.

Organization/Affiliation:

Military

SWAT

Other

Department/Organization Name:

Ship To Address:

City:

State:

Zip:

Your Title:

First/Last Name:

Email Address:

Department/Organization Phone:

Department/Organization Fax:

Your Portable Radio Manufacturer/Make/Model:

Breathing Apparatus Manufacturer/Make/Model:

Preferred Date of Delivery for Field Test:

How Did You Find Out About Atlantic Signal?:

Additional Comments:

Validation:

Enter this code into the Validation Box:

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ATLANTIC SIGNAL 21 DAY FIELD TEST FORM for Domestic Law Enforcement and Military Clients

ATLANTIC SIGNAL
21 DAY FIELD TEST FORM
for Domestic Law Enforcement and Military Clients