PNY Developer Unit Purchase Request Form

(All fields required).

Date Submitted
PNY Sales Representative

CONTACT INFORMATION:

Submitted By (Your Name)
Reseller Company Name
E-mail
Phone

END USER INFORMATION (if none, write "none")

End User Company Name

PRODUCT REQUEST 1:

Product Category
PNY Part Number
Quantity

PRODUCT REQUEST 2:

Product Category
PNY Part Number
Quantity

PRODUCT REQUEST 3:

Product Category
PNY Part Number
Quantity

PRODUCT REQUEST 4:

Product Category
PNY Part Number
Quantity
Demo Use Details
Potential Revenue Forecast (after successful testing)