Registered Opportunity Form

Step 1: Representative Information

* Name:
* Firm:
* Telephone:
* Email:

Step 2: Distributor Information (if involved)

* Company:
* Contact:
* Address:
*City:
*State:
*Zip:
*Telephone:
Fax:
*E-mail:

Step 3: Customer Information

*Company:
*Contact:
*Address:
*City:
*State:
*Zip:
*Telephone:
Fax:
*E-mail:

Step 4: Opportunity Information

*Part No.:
*Quantity:
*Expected Purchase Date:
*Expected Delivery Date:

Step 5: Competitor Information

Competitor Name:
Competitor Part No.:
Competitor Price:
Competitor Website:

Step 6: Notes

Notes:

Step 7: Submit