Drytac Dealer New Machine Sample Roll Request

Dealer Details
Your Company Name*
Your Name*
First Last
Your Email*
Your Phone*
Dealer Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
New Machine Details
What machine was purchased?
Printer Manufacturer and Model Number*
Ink Type and Ink Configuration*
Does the printer have white ink?*
- Yes
- No
RIP Software
Date Machine Is To Be Installed*
MM slash DD slash YYYY
Customer Details
Company Name*
Key Contact Name*
First Last
Customer Phone Number*
Customer Email Address*
Customer Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Shipping Details
Where would you like the starter kit sent?*
- Direct To Customer
- To Dealer
- Fulfilled By Dealer (From Dealer Inventory)

Dealer Details