Request for Information

If you would like more information about our products, please fill out our on-line form. We would like to know more about you, our potential customer too. You may print this form, fill it out and mail or fax it to us if you prefer to the following address:

Mail: GTEK, Inc., P.O. Box 2310, Bay St. Louis, MS 39521-2310

Fax: (601) 467-0935

Please fill out all applicable fields. Use the TAB key to move to the next field.

Thank you for your interest!

Contact Information:
First Name
Last Name
Address 1
Address 2 (Optional)
City
State/Province
Country
Zip/Postal Code
Day Phone Number
Fax Number (Optional)
Email Address

Additional Information

This information helps us learn a little bit about our customers. Please take a few moments to answer some questions:

Where will you use our product?
Home
Small Business
Large Business
Educational establishment
Non-profit organization
Government setting
Other:

If you are using our product within a business, what best describes your job function?
Executive Management (CEO, President, Principal)
Corporate Management (Financial, Admin, Operations)
Technical Staff
Sales or Marketing Management
Other:

For what do you primarily use your computer?
Spreadsheet
Word processing
Project scheduling
Accounting
E-mail
Presentation graphics
Personal finance
Education/reference
Programming
Games/entertainment
Desktop publishing
File Serving
Internet access
Groupware Applications

How did you hear about us?
Advertisement
Media review or other coverage
On the Internet
Direct mailing
Store display
Friend or colleague
Other:

In what manner do you expect our products to be of use to you?

Please tell us what products you would like more information on: (You can select more than one product)

Cyclone16/32
Cyclone 6
BlackBoard-8A
SmartCard-8
PCSS Intelligent Boards
PCSS Non-Intelligent Boards
EPROM Programmers
EPROM Emulators
Other:

Please tell us how you would like the information forwarded to you?

e-mail fax snail mail (make sure we have accurate addresses and phone numbers)

Thank you for your interest in GTEK products.