Product Evaluation Form

AV Technology Product Evaluation Request Form

We recognize that educators may want to get hands-on experience with our AV products in one of their own instructional spaces under real world conditions. To request a product or system for evaluation, please complete the form below.

All Fields Are Required

Requested Products

Please list below the products that you wish to evaluate

Consult the Extron web site for product name, model number, and part number

Evaluation Period

Select anticipated evaluation period

30 Days 60 Days 90 Days

All product evaluation items are subject to availability and are for the approved evaluation period of 30, 60, or 90 days unless arrangements are made to extend the evaluation period

Good Faith Retainer

Upon Extron approval of this product evaluation request, the requestor will be contacted to arrange for delivery. At that time, a valid purchase order or credit card number shall be furnished to Extron. Extron will bill against the purchase order or credit card number only if the evaluation items are not returned in good order at the end of the evaluation period or if the requestor notifies Extron that they wish to purchase the items.

Application Information

District/Institution Information

Name

Address

City

State / Province

Zip

Phone

Website

Applicant Contact Information

Name

Title

Phone

How did you hear about the Extron product evaluation program?

Briefly describe the application.

Size & Scope

Number of Schools / Campuses

Number of Classrooms / Instructional Spaces

Number of new schools / instructional spaces in the next 5 years

I acknowledge that I am the person listed above