NewWave: Our Value is Outside the Box

Sharp DX Deal Registration Form

Please complete the following application and click submit when complete. If you have any questions please contact us at 800-536-5222 ext. 353.

Scanner Distributor Name:

1. Please Provide the Following Information Regarding the VAR Requesting This Deal Registration:
VAR Name :
VAR Street Address :
VAR City :
State:		Zip Code:

VAR Contact Name :
VAR Contact Email :
VAR Web Address :

*2. End User Profile*
Name :
Title :
Company Name :
Department :
Street Address :
City

State

Zip Code:

*3. Describe the End user's Project/Application (how this equipment will be used):*

*4. What Actions/Activities Were Done by VAR to Influence the End User to Go With Sharp?*

*5. Sharp Products to be Registered:*
Model:	Qty:	Price to VAR:
Model:	Qty:	Price to VAR:
Model:	Qty:	Price to VAR:
Model:	Qty:	Price to VAR:
Model:	Qty:	Price to VAR:
Model:	Qty:	Price to VAR:
Model:	Qty:	Price to VAR:
Model:	Qty:	Price to VAR:

*6. Deal Registrations are Good for 90 Days From the Date Approval. If Longer Time Period Required Please Explain:*

*7. Additional Comments to Support Registration Requests:*

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