Please fill out this short questionnaire and we'll be in touch.

If you are interested in purchasing one of our robots, please respond to this questionnaire, or phone us at 719-447-0331, fax us at 719-447-0332 or send an e-mail message to info@robotfactory.com

* = required field

 Last Name*

     First*

 Title/Position

Company/Organization

Type of Business/Organization

Street* 

City*

State*

Country*

Zip/Mail Code*

Phone Number*

Fax Number

Email Address*

Application for Robots - Please check one.

Advertising/Promotion

Education

Entertainment Income

Rental

Distributorship

School Project

Hobby

Just Curious

Other (please specify)

Type of Robot preferred - please check applicable choices

Talking Sign

Mobile Robot

Animated Musician

Customized Robot

Uncertain

Ready to place order within - (check one)

Next 30 days

Next 6 months

Next year

Uncertain

Current Budget for Robots $

Have you seen one of our robots?

If so Where?

 PLEASE HAVE SOMEONE CONTACT ME IMMEDIATELY
TO DISCUSS MY INTEREST FURTHER

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