First Name *
Last Name *
Work Email *
Phone *
State *
INTL
AL
AK
AZ
AR
CA
CZ
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
CANADA
Category Type *
Education Customer
Business Customer
Healthcare Customer
Reseller - Education
Reseller - Business
Reseller - Healthcare
Reseller - Government
Distributor
Other
Title Group *
Teacher
Administrator
IT Department
Other
Reseller
Name of District/School/Business
How would you use the charging solution?
Devices charge overnight in school/org
Devices charged at home and need an extra charge during the day
Charging/storage needed for loaner/repair devices
More than one use case
Unsure
What grade levels need a charging solution?
Unsure
K-2
Elementary
Middle or Junior High
High School
Higher Education
Other
Preferred Mounting Option
Unsure
Wall Mount
Stands
A Mix
Roller
Preferred Power Supply
USB Power
Standard
Unsure
Make, Model, Size of Devices
Where did you hear about us? *
Customer Referral
Digital Ad
Direct Mail
Distributor
Email Campaign
N/A
Online Search
Print Ad
Repeat Customer
Reseller
Social
Trade Show
Anything else to share about your project and timeline?
I do not want to receive email communication from PowerGistics with exclusive updates on product information, new product launches, special offers, resources and invitations to events.
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