NTech Industries Incorporated

Military Information Form

Please complete the form and a sales associate will contact you with more information and pricing. Required Information
First Name*
Last Name*
Title
Military Facility*
Address 1*
Address 2
City*
State*	Zip Code*

Phone*	Area Code Number
Fax
Email*
	* required

Optional Information
This information helps us to indentify your needs.
How did you hear about the WeedSeeker?
	Click on any that applies (multiple choices are made by holding down the Ctr / Opt. key):
	If through a conference please specify:
Number of acres at your facility:
Main areas where you propose to use the WeedSeeker equipment:
	Click on any that applies (multiple choices are made by holding down the Ctr / Opt. key) :
Existing equipment at your facility:
	Click on any that applies (multiple choices are made by holding down the Ctr / Opt. key) :
What is your main interest for using the WeedSeeker equipment at your facility?
	Click on any that applies (multiple choices are made by holding down the Ctr / Opt. key) :

Optional Information