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Evaluation Request

30-day Evaluation Request

In order to evaluate DT Research’s products, please fill out the form below and click Submit.
(*Indicates a required field.)

* Customer/Requester's Name:
* Date Requested:
* Company Name:
* Contact Person:
Title:
* Phone:
* Address:
* E-mail:
* Model:
* Purpose:
* Estimated Return Date:
* Who Are You Working with at DTR: 
 
Shipping Address
* Address:
* City:
State:
* Zip/Postal Code:
* Country:
   
Shipping
Please provide your shipping account, and advise the shipping method
* Shipping Account:
* Shipping Method:
To ship via DT Research's shipping account, the freight will be precharged. Please fill out the Credit Card Authorization form sent by our sales for the freight.
 
Terms and Conditions
The above item(s) is/are a loaner(s) for the stated purpose. The item(s) shall be returned no later than the Estimated Return Date. By clicking the Submit button below, you hereby agree to pay the retail price for the item(s) if it/they is/are returned to DT Research with physical damage or lost during the period of evaluation. An invoice will follow in the mail for your records.
 
 
 
   
 If you encounter any problems filling out the form, please contact sales@dtri.com