Government Order / RFQ Submission

Authorized Government & Institutional Buyers Only

Complete the form below to submit a purchase order or request for quotation. A valid official government email address is required. All fields marked * are required.

1. Agency & Contact Information

Ordering Official Name *

Title / Position

Agency / Institution Name *

Agency Type *

Official Government Email *

Must be a .gov, .edu, .mil, or .us domain

Phone Number

2. Order Details

Items Requested / Line Items *

Include part numbers, descriptions, and quantities. One item per line.

Purchase Order (PO) Number *

Requested Delivery Date

PO Document Upload

Upload signed PO document (PDF, DOC, or image). Optional but recommended.

📄

Click to upload PO document

PDF, DOC, DOCX, JPG, PNG — max 10MB

3. Billing Address

Billing Contact / Agency Name

Street Address *

City *

State *

ZIP Code *

4. Shipping / Delivery Address

Same as billing address

5. Additional Information

Order Notes / Special Instructions

Installation requirements, access restrictions, packing, certifications needed, etc.

ADA Compliance Contact

Name and email of your agency's ADA Coordinator or Section 508 Officer if different from above

Order Confirmation Preview

See a preview of your confirmation document before submitting.

By submitting this form you certify that you are an authorized ordering official at an accredited government agency or qualifying institution.