The Z70 is here! Fill in the form below to get more information. Eligibility for the Z70 is contingent on satisfaction of criteria and application approval. Fields marked with an asterisk are required. 1. *First Name 2. *Last Name 3. *Address 4. *City 5. *State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Island Virginia Washington West Virginia Wisconsin Wyoming 6. *Zip Code 7. Text Number 8. Videophone Number 9. Promo Code 10. Event Code 11. *Which VRS are you currently using? New to VRS Sorenson Purple Convo Global ZVRS 12. *Are you willing to switch your primary Videophone Number to Z? Yes No 13. *Email Address 14. *New or Existing customer? New Existing 15. If you are an existing customer, please enter your username 16. *Are you deaf or hard of hearing? Yes No 17. *Do you use ASL? Yes No 18. *What type of internet connection do you have? Cable DSL Wireless None 19. *Who is your internet service provider? Comcast Time Warner Brighthouse AT&T Verizon Other 20. If you selected 'Other' for your internet provider please enter it here: 21. *What type of computer do you have? PC Mac None 22. *Is this for personal or business use? Work Home 23. *If the Videophone is for personal use, where is it located in your household? Home Office Living Room Bedroom Other 24. If you entered 'Other' for your Videophone location please enter it here: 25. *How did you hear about us? Website Event Tradeshow Referral Social Media Advertising Email Other 26. *What product are you applying for? Z70 i3