Special Pricing Request

* = Required Fields

Tell me you are a bot:
Requestor name*  
End user*  
End user address line 1
End user address line 2
End user city, state & ZIP*  
Reseller*  
Reseller contact name*  
Reseller e-mail*  
Reseller phone*  
Distributor(s)*


Competitor(s)
Competitor’s SKUs
Competitor’s end-user price
End-user deal target price
Reseller target price
Distribution target price
Probability of win with SP
Expected order date(s)*  
Expected ship date(s)*  
One-time buy or Initial qty & roll-out plan
Type of request
If Extension, volume history
Reason for special pricing*  
List all items that are part of complete configuration, even if rebate is not needed:
P/N #1
Part number 1*  
Quantity for 1*  
Rebate for 1*  
P/N #2
Part number 2
Quantity for 2
Rebate for 2
P/N #3
Part number 3
Quantity for 3
Rebate for 3
P/N #4
Part number 4
Quantity for 4
Rebate for 4
Check box if more than 4 P/Ns