Lead Generation Form

Now you have an opportunity to participate in the booming sales of Omitec, Inc. products. Just give us a name and an address of a shop or person interested in our products. Following this lead, if we sell any products to this party we will give you a finder's fee for you efforts.

Complete the form below and then click the submit button. Please make sure you have read and understood the terms and conditions listed below. This offer is only good for locations within the United States.

Your details

Your first name
Your last name
Company
Street address
City
State
Zip code
Phone
Fax
E-mail
Prospect's Details
First name
Last name
Title
Company
Street address
City
State
Zip code
Phone
Fax
E-mail
Which Omitec products would the prospect like to see at his shop?
Omitec PDA2100A Ignition Analyzer
Omitec PDA Emission Bench (4-Gas)
Omitec PDA Emission Bench (5-Gas)
ECVu - The ECM Analyzer
PC-LINK - PC connectivity software
Other
Please use the space below to provide any special requirements concerning the on-site product demonstration

Terms and conditions:
If your lead is accepted by Omitec, it will be protected for a period of 60 days from the date of receipt by Omitec. If the prospect named above has already been contacted by another party, in connection to a sale of Omitec's product(s) prior to the receipt of your lead - you will be notified and your lead will be rejected by Omitec.
If a sale of a product, by Omitec or its representative, pursuant to a lead accepted by Omitec, to the prospect named above is completed - you will be paid a Finder's Fee on the sale.
The Finder's Fee will be paid at a rate of 10% of the net revenue received by Omitec or $500, whichever is less. The Finder's Fee will be paid on the 15th of the month following the month in which Omitec is paid in full for the product sold pursuant to the lead.

Lead Generation Form

Your details

Prospect's Details