T&E KIT REQUEST

Reflex Protect Presidia Gel® and Reflex Remove®

In order for us to provide a free sample for your review, we request a bit of information about your agency.
* Questions are required.

LIMIT ONE KIT PER DEPARTMENT. PLEASE COMPLETE ONE FORM FOR EACH AGENCY.

FIRST NAME

LAST NAME

PHONE

CHIEF/SUPERVISOR NAME

CHIEF/SUPERVISOR NAME PHONE

CHIEF/SUPERVISOR NAME EMAIL

DEPARTMENT

ADDRESS FOR MAILING SAMPLES - NO POST OFFICE BOXES

CITY

REGION/STATE/PROVINCE

POSTAL/ZIP CODE

HOW MANY SWORN OFFICERS IN YOUR DEPARTMENT?

HOW MANY CORRECTION OFFICERS IN YOUR DEPARTMENT?

HOW OFTEN DOES YOUR DEPARTMENT PURCHASE LESS LETHAL SPRAY?

AVERAGE ANNUAL BUDGET

TRAINING BUDGET

MONTH YOUR BUDGET IS APPROVED

SPRAY PRODUCTS YOU CURRENTLY USE?

WHAT ARE THE MOST IMPORTANT FACTORS WHEN CHOOSING A BRAND?

Customer Service

Price

Training/ReCert

One Stop Shopping

ARE YOU SUBMITTING THIS ON BEHALF OF AN AGENCY AS A DEALER OR DISTRIBUTOR? IF SO, PLEASE LIST COMPANY AND NAME.

DO YOU HAVE ANY QUESTIONS/COMMENTS?