DV Matic :: ELO Media.com

Contact >> Purchase Request Form

Purchase Request Form

To receive an Information Packet from ELO Media, please fill out the information below:

Purchasing Information Request Form:
First Name*		Address*
Last Name*		City*
Company Name*		State*
Telephone*		Country*
E-mail*		Zip*

How many machines are you looking to purchase?
1-5 Machines
6-10 Machines
Above 10 Machines
Don’t know

When are you anticipating placing an order?
1 week
2 weeks
Longer than 2 weeks

Are you interested in leasing?
Yes
No
I have my own financing source

How much do you plan on investing?
Less than $20,000
$20,000 - $40,000
$40,000 - $60,000
More than $60,000


Do you have a location to place the machine?	Yes No
Subscribed to our monthly newsletter?	Yes No

Please type any question or comments along with the best time to contact you.

ELO Media will assess the information you have sent and will contact you directly. If you have any questions please call us directly at (866) ELO-DVDS.