First Name :
Last Name :
Company Name :
Company Address :
City :
State / Province :
Zip / Postal Code :
Country :
* Phone Number :
Fax Number :
* Your Email Address :
Would You Like To Receive a Demo CD + Literature ASAP?	Yes No
Do You Currently own an Embroidery Machine?	Yes No
Which Brand?
I would like information on :	for more information on these products, visit the equipment section of our site
Please indicate the quantity of each machine you own:
Single Head Choose 1 2 3 4 5 6 7 8 9 10 11+ Twelve Head Choose 1 2 3 4 5 6 7 8 9 10 11+ Double Head Choose 1 2 3 4 5 6 7 8 9 10 11+ Fifteen Head Choose 1 2 3 4 5 6 7 8 9 10 11+ Four Head Choose 1 2 3 4 5 6 7 8 9 10 11+ Eighteen Head Choose 1 2 3 4 5 6 7 8 9 10 11+ Six Head Choose 1 2 3 4 5 6 7 8 9 10 11+ Twenty Head Choose 1 2 3 4 5 6 7 8 9 10 11+ Eight Head Choose 1 2 3 4 5 6 7 8 9 10 11+ Twenty-Four Head Choose 1 2 3 4 5 6 7 8 9 10 11+
Other significant machinery?
Our material is mailed to addresses within Canada and the  United States only. International or RUSH please provide your courier of choice and account number below#.
Courier	FedEx UPS DHL Other:
Courier Account Number
* = Manditory Fields

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Speak to us directly by calling 1-888-442-7929 and ask for an GMI Laser ® specialist. (Hours Mon-Fri 9 a.m. - 5 p.m. EST)

Thanks again for your interest in the latest, most profitable decorations the market has to offer!

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GMI Laser® mailing address:

220 Industrial Parkway South, Unit 15
Aurora, ON, L4G 3V6
Canada

Voice: 905.713.6514
Fax: 905.713.6506
Email: info@gmilaser.com

USA Mailing Address:
1623 Military Rd. #704
Niagara Falls, NY 14304-1745
Tel: 1-888-442-7929 Fax: 1-877-552-7375
GMI Italy