Business/School/Organization Information

Business/School/Organization Name

Select which best describes your business/school/organization:

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Website

Delivery Address (if different then organization address above)

* Each PowerCart weighs 250lbs. and will be delivered freight which will require that the recipient be able to receive and secure the unit/s.

Loading Dock Access?*

Yes
No - If there is no loading dock at the delivery address addtional service charges may be required.

If you do not have a loading dock will you require assistance to move the unit/s?*

Delivery Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name*

First Last

Email*

Phone*

What type of headset will you be storing in your PowerCart?

If you selected 'Other' for headsets...

How did you learn about Looking Glass XR Powercarts?*

If you selected 'Other'...

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Email

This field is for validation purposes and should be left unchanged.