<p>Interested in a quote for a standard or modified product? Contact us at <a href="tel:8478448795">(847) 844-8795</a> or <a href="mailto:[email protected]">[email protected]</a>. You may also fill out the form below and we’ll respond to your request within 48 hours.</p> <form id="quote-request-form" class="kwes-form" action="https://kwesforms.com/api/foreign/forms/4D1YUC8wQTzRuKEmccyi"> <div class="form-row form-row--half"> <div class="form-field"><label class="form-label" for="q-first-name">First Name <small>Required</small> </label> <input id="q-first-name" class="form-input" name="first_name" type="text" /></div> <div class="form-field"><label class="form-label" for="q-last-name">Last Name <small>Required</small> </label> <input id="q-last-name" class="form-input" name="last_name" type="text" /></div> </div> <div class="form-row form-row--half"> <div class="form-field"><label class="form-label" for="q-phone">Phone Number <small>Required</small> </label> <input id="q-phone" class="form-input" name="phone" type="tel" /></div> <div class="form-field"><label class="form-label" for="q-email">Email Address <small>Required</small> </label> <input id="q-email" class="form-input" name="email" type="email" /></div> </div> <div class="form-row form-row--half"> <div class="form-field"><label class="form-label" for="q-company-name">Company Name <small>Required</small> </label> <input id="q-company-name" class="form-input" name="company_name" type="text" /></div> <div class="form-field"><label class="form-label" for="q-industry">Company Industry <small>Required</small> </label><select id="q-industry" class=" form-select" name="companyIndustry"> <option value="">Select Industry</option> <option value="Agriculture/Transportation">Agriculture/Transportation</option> <option value="Audio/Video">Audio/Video</option> <option value="Education, Military">Education/Military</option> <option value="Fire & Safety">Fire & Safety</option> <option value="Food & Beverage">Food & Beverage</option> <option value="Gaming/POS/Vending/Kiosk">Gaming/POS/Vending/Kiosk</option> <option value="HVAC">HVAC</option> <option value="Industrial Controls">Industrial Controls</option> <option value="Medical">Medical</option> <option value="Oil, Gas, & Energy">Oil, Gas, & Energy</option> <option value="Telecom/Communications">Telecom/Communications</option> <option value="Test & Measurement">Test & Measurement</option> <option value="Other">Other</option> </select></div> </div> <div class="form-row form-row--half"> <div class="form-field"><label class="form-label" for="q-company-type">Company Type <small>Required</small> </label><select id="q-company-type" class=" form-select" name="companyType" required=""> <option value="">Select Category</option> <option value="CM/EMS/R&D">CM/EMS/R&D</option> <option value="Consumer Devices">Consumer Devices</option> <option value="Individual">Individual</option> <option value="Manufacturer/OEM">Manufacturer/OEM</option> <option value="Distributor">Distributor</option> <option value="Reseller/Broker">Reseller/Broker</option> </select></div> <div class="form-field form-field--input form-field--inputText"><label class="form-label" for="q-company-website">Company Website <small>Required</small> </label> <input id="q-company-website" class="form-input" name="companyWebsite" required="" type="text" /></div> </div> <div class="form-row"> <div class="form-field"><label class="form-label" for="q-address">Company Address <small>Required</small> </label> <input id="q-address" class="form-input" name="company_address" type="address" /></div> </div> <div class="form-row"> <div class="form-field"><label class="form-label" for="q-products">List the product's model number you are interested in. <small>Required</small> </label> <input id="q-products" class="form-input" name="products" type="address" /></div> </div> <div class="form-field"><label class="form-label" for="q-comments">Comments/Questions <small>Required</small> </label> <textarea id="q-comments" class="form-input" cols="50" name="comments" rows="3"></textarea></div> <div class="form-row"> <div class="form-field form-field--input"><label class="form-label"> Attach documents (pdf, doc, docx, txt, jpeg, jpg, or png file - 7MB limit) <small>Optional</small></label> <input name="upload" type="file" /></div> </div> <div id="recap" class="form-row"> </div> <div class="form-actions"><button class="button button--primary" type="submit">Submit</button></div> </form>
