Airline Name
Airline ID or IATA Code {WN|UA|DL|etc.}
First Name*
Last Name*
Position
Primary Email*
Primary Phone*
Secondary Email
Mobile Phone
Street
Postal Code
City
State
Country
Twitter Username
WhatsApp
Skype
Number of Pilots
Number of Employees
FAA | EASA Operation Category {121|91|etc.}
Current Fleet – Types and Approx. Counts
Current EFB Device{s}
Current Mount System – {RAM|STC and types}
Current EFB Cockpit Power Solution
Current EFB Program Info
Desired EFB Device{s}
Desired Mount Class
Desired PIVOT Mount Solution	Suction CupFlyPad TrayJetBag MountAXIS MountClass 2Class 3Other
Desired Device Power {Personal|Provided|Installed}
Have Device Fire Protection Bags been deployed?	Select ValueYesMaybeAlready have a solutionNoWe don’t believe it to be an issue
Regulatory Needs
Referred by
Customer File (Optional)
Customer File (Optional)