Quote Request Form

*All fields are required.

Name:

Company:

Phone:

Email:

Please confirm your e-Mail:

Select Cabinet Style and LCD Size:

Axis 22"
Axis 19"
Millennium 22"
Millennium 19"
Velocity 26"
Please make a selection

Quantity (check all that apply):

25 50 100 250 500 1000

Finishing Options:

Chrome
Painted (Powdercoat)

Top Box Options:

Backlit Top box (CCFL)
Dual Screen
No Top box

Belly Door Styles (Upright styles only):

Square Belly
Round Belly

Include LCD(s)?

Yes No

Include PDU?

Yes No

Include Meters?

Yes No

Include Sub-woofer?

Yes No

Include Tower Light?

2-Tier with Inserts
3-Tier with Inserts
No Tower Light

Include Player Tracking Plate?

Blank Plate (No cut-outs)
Custom Plate

Include Printer?

No Printer Ithaca/Epic FutureLogic Other

Include Bill Acceptor?

No DBV MEI/Mars JCM Ardac CashCode Other

Optional comments or special instructions: