Microsoft Surface Pro Tablet Request Form

About Personal Information Protection

The personal information in this form is used for replying to the customer's inquiry.
In some cases, inquiries with personal information may be forwarded to appropriate Hitachi group companies in order to reply to the customer directly.
Personal information is properly managed on the basis of "About Personal Information Protection" (opens in a new window) at Hitachi Kokusai Electric Inc.
Also, if you do not agree with these terms and conditions, your inquiry submission will be cancelled.

By checking this box, you acknowledge that you have read the About Personal Information Protection information.

Please fill out the form below to request the Microsoft Surface Pro Tablet PC promotion for your purchase of three (3) or more Hitachi cameras with IP-capable CCUs. We will confirm receipt of your request via Email. Contact us via Email at bpsales@hitachikokusai.us or call our toll free number (855) 891-5179 during normal business hours.

The fields indicated with an asterisk (*) are required.

Contact Information

Company *
Name * First name *
Middle Initial
Last name *
Address *
City *
State/Province *
Zip/Postal Code *
Country *
Email *
Company Phone *
Cell Phone *

Camera Products Purchased (Minimum of 3 cameras required)

Camera #1 * Model *
Serial No. *
Camera #2 * Model *
Serial No. *
Camera #3 * Model *
Serial No. *
Dealer or Reseller *
Date of Purchase *