Internal Lead Form for Customer Care and Sales Associates

To submit a rental sale or lead, choose “Rentals”.

    Required fields are marked with an asterisk (*).

    Do you know the part number(s) you wish to order? YesNo

    Bill To:

    Same as above

    Order Information

    Order Parts:

    Please input as much information as you know and we'll help you find the part you're looking for.

    Machine Information:

    Additional contact requests:
    Please have a sales person contact me

    Please note: If you, somehow, managed to find this page and you’re not one of Bortek’s employees, you can simply ignore what’s here as it offers no value to you. We highly recommend checking out the content on these pages though!!

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