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Request for Special Pricing

(* Required Field)
delta_bluePricing Request For
Value Added (ADVANTAGE Program) Volume Discount (RFQ for 50+ units)
Request for Quotation / Tender In-House Demo
delta_blueReseller Information
Company Name:
Contact Name:
Phone Number:
Email Address:
delta_blueEnd-User Information
Organization Name:
Contact Name:
Phone Number:
Email Address:
delta_blueHardware Information
Scanner Model:
Quantity:
Option:
Extended Maintenance:
Yes
ScanAid Kit:
Yes
End-User Considering Other Brand(s)?:
No; if yes, please enter Manufacturer(s) / Model(s):
Expected Close Date:
delta_blueSoftware Information
Select "Yes" if providing Fujitsu bundled scanner software only:
Yes
Enter name of customized imaging software you are installing:
Details:
By clicking on the “submit” button below, you, a Fujitsu imaging reseller, acknowledge that you have a bona fide opportunity with an end user and that you will comply with all of the ADVANTAGE program terms and conditions.