First Name: Last Name: Company Name: Address: State / Province: Select State Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming --- OTHER Country: Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Barbuda Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Botswana Bouvet Island Brazil British Indian Ocean Trty. Brunei Darussalam Bulgaria Burkina Faso Burundi Caicos Islands Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Island Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Futuna Islands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Herzegovina Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Jan Mayen Islands Japan Jordan Kazakhstan Kenya Kiribati Korea Korea Kuwait Kyrgystan Lao Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mc Donald Islands Mexico Micronesia Miquelon Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles Neutral Zone Nevis New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Principe Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts Saint Lucia Saint Pierre Saint Vincent Samoa San Marino Sao Tome Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand The Grenadines Tobago Togo Tokelau Tonga Trinidad Tunisia Turkey Turkmenistan Turks Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Viet Nam Virgin Islands Virgin Islands Wallis Western Sahara Yemen Yugoslavia Zaire Zimbabwe Zip / Postal Code Phone: E-Mail Address: Professional Affiliation: Tactical / Law Enforcement US Government / US Military Security / Surveillance Geological / Scientific Robotics / Educational Site Survey / Inspection Search and Rescue Floor / Facility Guidance Personal Assitance Distributer / Value Added Other Preferred Product Delivery Schedule: 1 to 3 Weeks 3 to 8 Weeks Expedited TBD NOTE: Select a REV9 RFO system ( REV9-18 or REV9-16 ) below OR select "Need Full Customization" and proceed with "Customization Options". Assembled & Ready For Operation (RFO) REV9 UGV System (select one) REV9-18 RFO As Advertised REV9-16 RFO As Advertised Need Full Customization > Quantity: 1 2-10 10-50 50+ Rc Rover™ Chassis & Additional Options (press "Ctrl" key to select multiples) RC ROVER REV9-18 (18") RC ROVER REV9-16 (16") ROVER-X (28" 120+Lbs) Need Further Customization None Painted Chassis Anodized Chassis REV9 Hardware Kit Need Further Customization None

Drive System eXPANDHUB + Wheels + Tracks eXPANDHUB + Wheels + 10" Tires eXPANDHUB + Wheels Need Further Customization None Motor / Encoder 2 x Super Torque (REV9-18) 2 x Heavy Torque (REV9-16) 4 x Heavy Torque (REV9-16) 2 x Super Torque + Quad Encod 2 x Heavy Torque + Quad Encod 4 x Heavy Torque + Quad Encod Need Further Customization None Controller (press "Ctrl" key to select multiples) PC / RC Onboard Controller PC-Only Onboard Controller RC-Only Onboard Controller Onboard UMPC with LCD Operator A/V and Arm TX Radio Operator UGV TX Radio Operator UMPC WIFI Unit Need Further Customization None Robot Arm & Lift Capacity 14" Arm/Gripper 28" Arm/Shoulder/Gripper Need Further Customization None 3Lbs Capacity 5Lbs Capacity 8Lbs Capacity Need Further Customization None Surveillance system (press "Ctrl" key to select multiples) IR Cam (150ft Night LOS) IR Cam (27ft Night LOS) Stereo Vision IR Cam Locator Headlight Single 4" Field Monitor Dual 4" Field Monitor 12" Field Monitor Omnidirectional Microphone 1 x Pan/Tilt for IR Cam 2 x Pan/Tilt for IR Cam Need Further Customization None A/V/D Range 1000ft-6000ft LOS 5 Miles LOS 20 Miles LOS Need Further Customization None Carrying Case (press "Ctrl" key to select multiples) Pelco UGV System Case A/V Case Need Further Customization None Sensors / Active Payload (press "Ctrl" key to select multiples) Proximity / Ultrasonic (4 each) PC Based Single Vision PC based Stereo Vision Gas Sensor / Detector Temprature / Humidity Sensor GPS Telemetry System Thrust & Angular Sensor Need Further Customization None Software Embedded REV9 RFO S/W REV9 Onboard Sensory S/W Embedded Autonomous S/W Need Further Customization None

Order Delivered (select one): Assembled & Ready For Operation Assembled Not RFO Untapped & Unassembled Describe Your Project, Adiitional Customization, & Requirements As Applicable (this field is required):