VideoRay Registration Form

Contact Information (Items with a * are required)

Primary User/Contact*
Company
Address*

ZIP/Postal Code*
State*
Country
Phone*
Fax
E-Mail

Submersible Serial #*
Purchased From*
Date Purchased*

Usage Information *

Fresh Water Salt Water

Maximum Expected Depth: Feet Meters

Type of Vessel (or Dock):

Type of Power Source:

What type of display and/or recording device(s) will you be using?

Television
VideoCassette Recorder
TV/VCR Combo
Video Monitor
Camcorder
Head Mounted Display
Portable DV Recorder
Other:

Describe Usage Briefly

How did you hear about us?

Is there a colleague/associate who might be interested in learning more about VideoRay?

Name
Address

ZIP/Postal Code
State
Country
Phone
E-Mail

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