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 (*).

BuyGeneral Info
They'd like to schedule a demoThey'd like to request a quote
Where the buying decision will be made:

Where the product will be used:

Additional contact requests: Please have a sales person contact meRequest an on-site survey

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:

Lead is out of territory (or) Customer needs a survey (or) Customer is unsure if renting or buyingNone of the above
Which is it?* LEADSOLD
Should the sweeper be...Street legalAble to reach highway speeds
Desired power source:
On-site contact, if different from above:
Facility/Customer Type*
Floor/Surface Type

Send me more informationContact me to schedule a free onsite demo
Does your service address differ from your company address? YesNo

Unit Information #1

Service Needed*
EstimateRepairMachine is Down

Do you need additional units serviced?
YesNo

Unit Information #2

Service Needed*
EstimateRepairMachine is Down

Additional contact requests:
Please have a sales person contact me

Request additional information about:
PartsServiceStreet SweepersSupplies

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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