Electrochromics Questionnaire
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 * Required Items

* Name:
* Title:
* Affiliation:
* Address:
* Phone:
* Email:
Reason for Query:	Scientific Interest		Purchase
	Test		Other
Heard of Us Through:	Search Engine		Ad/Brochure
	Referral		Other
Looking for:	Free Sample		Rental
	Purchase		Other
Your Needs:	One Time		Testing/Evaluation
	Recurring		Other (include below)
	Please list any other needs such as the approximate number of devices, size, shape, substrates (metal? composite? clothing?) below:
Spectral  Region of Interest  (select all that apply)	3 to 5 microns	8 to 12 microns		Visible
	Near-IR	Microwave
	Other:
Other Information:	Is this a subsystem (i.e. one component) which is part of a larger, multi-component system?   Yes   No   Don’t wish to say.
	List any special needs including field lab assistance from Dynamir personnel in testing and evaluation below:
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