Demo Request form

Please complete the following contact information.

We request that all information be supplied in order to ensure prompt and efficient delivery of the instrument to you. Your evaluation period will begin on the date instrument is delivered and will end one (1) week from that date. You will be advised of these dates. The dates can be adjusted due to special circumstances. If you have questions, please contact our office. Our toll free number: 888-848-3783 ext.691.

Select Product:

Please specify desired evaluation date:

First Name:
Last Name:
E-mail Address:
Telephone Number:
Fax number:
Company Name:
Mailing Address
I request that Zylux Corporation deliver a demonstration unit to my facility for evaluation purposes. I understand that I am responsible for the return of the instrument to Zylux Corporation, c/o Titertek Instruments, 330 Wynn Drive, Huntsville, AL 35805 via UPS Ground, FedEx Ground or United States Postal Service. Agree with the listed above conditions.
Initials:		Date:
Special Instructions: