ACADEMIC IMAGING ASSOCIATES
Form to SECURE PRICING and GENERATE A QUOTATION

Complete this section for
PRICING on INDIVIDUAL ITEMS
(Be sure to complete Contact Information below including telephone number)

Complete this section for
FORMAL QUOTES on a LISTED AIA SOLUTION:
(Be sure to complete Contact Information below including telephone number)

CONTACT INFORMATION
Please contact me via enclosed information.
(I understand my name, address, etc. will be held confidential and
not be sold or shared with other organizations.)

Name   
Title Affiliation 

Phone  Fax
Email 

Address   City  
State Zip

NOTE: If this form is not ACTIVE as yet please print it, fill it out
and fax it to 802 362-0760 or mail it to the address indicated directly below