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Customer Information |
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| Customer Type* |
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| Company Name* |
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| Business Telephone* |
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| Your Name* |
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| Your Telephone* |
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| Email Address* |
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| Mailing Address* |
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| City* |
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| State/Province* |
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| Postal Code* |
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| Country* |
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Business Information |
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| Business Type* |
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| Name of VAR/Distributor* |
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| Business Telephone |
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| City |
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| State/Province |
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| Postal Code |
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| Country |
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| VAR/Distributor Contact Name |
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| Email Address |
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| Did you purchase product from a Catalog or Website?* |
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| If Website, please provide URL |
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About your unit |
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| Is this equipment installed? |
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Yes
No
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| Is this a new install? |
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Yes
No
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| Is this network growth? |
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Yes
No
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| Are you a ServPak Customer? |
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Yes
No
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| If yes, what is your ServPak contract number? |
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| May we e-mail you Technical Support Update Bulletins
related to the Proxim products you've registered? |
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Yes
No
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| May we e-mail you information on other Proxim products
and promotions? |
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Yes
No
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Product information |
| Product 1* |
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SN #* |
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| Date Purchased* |
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Other |
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| Product 2 |
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SN # |
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| Date Purchased |
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Other |
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| Product 3 |
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SN # |
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| Date Purchased |
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Other |
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| Product 4 |
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SN # |
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| Date Purchased |
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Other |
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| Product 5 |
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SN # |
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| Date Purchased |
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Other |
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| Product 6 |
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SN # |
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| Date Purchased |
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Other |
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| Product 7 |
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SN # |
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| Date Purchased |
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Other |
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| Product 8 |
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