Agency Name*
Organization Name (If Not Enforcement Agency)
Type of Agency*
--None--
Airport Police
Campus/University Police
Canadian Police Service
County Police
Federal
Fire Marshals
Harbor Police
Marshal's Office
Military Police
Municipal Police
Park Police/Rangers
Privatized Police
Railroad Law Enforcement
Sheriff's Office
State Police/Hwy Patrol
Texas Constable
Training (non-federal)
Transit Police
Tribal Law
Law Enforcement Related
Number of Sworn Officers
Federal Department*
--None--
Department of Agriculture
Department of Commerce
Department of Defense
Department of Energy
Department of Health and Human Services
Department of Homeland Security
Department of the Interior
Department of Justice
Department of State
Department of Transportation
Department of the Treasury
Department of Veterans Affairs
Other
Street Address*
Building and / or Suite #
City*
State / Province*
-- SELECT --
AL - Alabama
AK - Alaska
AS - American Samoa
AZ - Arizona
AR - Arkansas
CA - California
CO - Colorado
CT - Connecticut
DE - Delaware
DC - District of Columbia
FM - Federated States of Micronesia
FL - Florida
GA - Georgia
GU - Guam
HI - Hawaii
ID - Idaho
IL - Illinois
IN - Indiana
IA - Iowa
KS - Kansas
KY - Kentucky
LA - Louisiana
ME - Maine
MH - Marshall Islands
MD - Maryland
MA - Massachusetts
MI - Michigan
MN - Minnesota
MS - Mississippi
MO - Missouri
MT - Montana
NE - Nebraska
NV - Nevada
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NY - New York
NC - North Carolina
ND - North Dakota
MP - Northern Mariana Islands
OH - Ohio
OK - Oklahoma
OR - Oregon
PW – Palau
PA - Pennsylvania
PR - Puerto Rico
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VI - Virgin Islands
VA - Virginia
WA - Washington
WV - West Virginia
WI - Wisconsin
WY – Wyoming
AB - Alberta
BC - British Columbia
MB - Manitoba
NB - New Brunswick
NL - Newfoundland and Labrador
NT - Northwest Territories
NS - Nova Scotia
NU - Nunavut
ON - Ontario
PE - Prince Edward Island
QC – Quebec
NA – International
Zip/Postal Code*
Country*
-- SELECT --
United States of America
Canada
---
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of The
Cook Islands
Costa Rica
Côte D'ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Puerto Rico
Peru
Philippines
Pitcairn
Poland
Portugal
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and The Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and The South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
Uruguay
Uzbekistan
Vanatu, Republic of
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Business Phone*
Web Site
What Vehicles Are Currently Utilized?* (Ctrl+click to select multiple)
Chevy Impala
Chevy Tahoe
Dodge Charger
Dodge Durango
Dodge Intrepid
Dodge Magnum
Ford CVPI
Ford Expedition
Ford Explorer
Ford Taurus/500
Hummer H3
Jeep Cherokee
Total Marked Vehicles in Fleet
Total Unmarked Vehicles in Fleet
Average # of Vehicles Purchased Annually
Purchasing Authority Resides With (Name or Title)
Is a Take Home Vehicle Program Used?
How Many Take Home Vehicles?
--None-- 1-5
6-10
11-25
26-50
51-100
101-150
151-250
251+
Salutation*
-- Mr.
Ms.
Mrs.
Dr.
Prof.
First Name*
Last Name*
What is Your Role?* (Ctrl+click to select multiple)
Active Duty Law Enforcement (sworn)
Retired Law Enforcement (sworn)
Fleet Administration (sworn)
Fleet Administration (non-sworn)
Law Enforcement Activist Group
Law Enforcement Related Professional
Law Enforcement Training (sworn)
Law Enforcement Training (non-sworn)
Government Official
Rank*
--None--
Non-Sworn
Officer / Trooper / Patrolman / Deputy / Constable
Detective / Investigator
Corporal
Sergeant
Lieutenant
Captain
Major
Colonel / Commander
Assistant or Deputy Chief of Police / Sheriff
Chief of Police / Sheriff
Agent
Special Agent / Inspector
Special Agent in Charge
Director
Executive Director
Deputy Assistant Secretary
Assistant Secretary
Chief of Staff
Deputy Commissioner
Commissioner
Title
Department / Functional Area
K-9 Officer?
Mobile Phone
Email*
Comments or Additional Information
Provided that Carbon Motors Corporation will build the Carbon E7 to my specification after I have selected from over 50 options on the vehicle, that the vehicle will provide a lower total cost of ownership, and that it will be backed by a comprehensive service program, I believe my law enforcement agency interest would have a
--- SELECT ---
High Level of Interest
Medium Level of Interest
Low Level of Interest
No Level of Interest
in purchasing the Carbon E7 vehicle for our law enforcement operations.*
Purchasing authority for my agency resides with me and I would like to be contacted so I can learn more about how I might reserve a no-obligation production slot for the Carbon E7.