Demo Request

Demonstration Request

Want a no-obligation free demonstration unit for in-house evaluation? Enter your information here and we will contact you within 24 hours to set up a free, no-obligation evaluation unit shipped to your facility within one to two days*. Fields marked with a red asterisk (*) are required.

Your information will not be sold or shared with third parties.

Your Information
Title	None Mr. Miss Mrs. Dr.
First Name *
Last Name *
Email Address *
Confirm Email Address *
Daytime Phone	( ) -      ext:
Shipping Address
Facility Name *
Department
Attention Field
Address *
Address 2
City *
State *
ZIP Code *
What product(s) were you interested in evaluating?	Headlights
Check all that apply.	White Sun® Surgical headlight X781HL
	White Sun® Sweatband Headlight X781HL MOD
	Single Traditional Headlight X772HL
	Bifurcated Trad. Headlight X773HL
	Minnie Traditional Headlight
	Minnie Sweatband Headlight X779HL
	Light Sources
	300 Watt Xenon White Sun XL300N
	175 Watt Xenon White Star XL175
	Dual 300 Watt Xenon White Sun XL300N
	Dual 175 Watt Xenon White Star XL175
	200 Watt Halogen Small Sun XL200
	Light Source Stands
	4Ft. Floor Stand (Blue) X3114
	4.5Ft. Chrome Floor Stand (Chrome / White) X3114 W
Finally, How would you like us to contact you?	Via Email Please Call
Do not check this box.
Spam Check:	Enter the letters you see above*:

*Typical estimated shipping time. Actual delivery time may vary. Offer dependant on stock on hand. Demonstration units available in USA only. Recipient pays all shipping charges incurred.