E-mail Address:*

First Name:*

Last Name:*

Address:*

Street1:

City:*

State:*

Postal Code:*

Company:

Telephone:*

Fax #:

1. Approximately how many remotes do you need annually?

2. Type of device(s) (Cable Box, Lighting, etc.)

3. Number of devices to be controlled:

4. Functions required (On, Off, Mute, etc.)

5. IR (Infrared), RF (Radio Frequency) or both:

6. Power source prefered (AAA, AA, rechargeable):

7. Backlit buttons required (yes/no):

8. "Learning" function required:(Yes /No /NA):

Briefly describe your OEM project & requirements: