Special Pricing Request Form

Date

Submitted By

Phone

Notify Sales Representative

Sales Representative Email Address

Reseller Company Name

Reseller Country

Reseller State

End User Company Name

Sourcing Distributor of Choice (1)

Sourcing Distributor of Choice (2)

Product Category

Product

Networking Adapters

Networking Cables

Networking Switches

Product SKU

End User Company Address

End User Contact Name

End User Contact Email

End User Contact Phone

School Contact Name

School Email Address

Quantity / Estimated Annual Usage

Single Purchase

Roll Out Purchase

Units Per System

Current Distribution Cost

Requested Distribution Cost

Competitor(s)

Competitive Cost

Project Start Date

Project End Date

Intended Use Case / Application

Other Intended Use Case / Application Description

Justification to Consider Special Pricing