BenQ B2B Deal Registration Form
 * Required
End User Contact Information:
End User Name:*
End User State :*
End User Contact Person :
First Name: :*
Last Name:*
Email Address :*
Phone Number :*
Opportunity Specifics
 Model Number:*
Target Reseller Price:*
Target End User Price:*

Accessories :

Preferred Distributors:*

Notify Distributor about this deal? :*
Need BenQ Sales Rep. to contact:  
I have a Rep:
Special Warranty Requirement:

[notice our standard warranty is 1 year]
Bid Close Date :*  
Bid Delivery Start Date:*  
Total Months of Delivery:
Upload Bid Specification details :
End user consider other brands:?*  
Additional Comment:
Reseller Information
Send e-mail acknowledgement to:*
Reseller Business Name:*
Reseller Contact Person's First Name:*
Last Name:*  
Reseller State:
Phone Number:*
Fax Number:
Is BenQ the specified product?:
Is it first time registering deal with BenQ?:
Offer Technical Service:
Describe your involvement with this deal:
Product demonstration date for end user:  
Offer Installation Service:
I would like to receive:*  |  2014 BenQ America Corp. All rights reserved
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