DESIGN FORECAST/REGISTRATION FORM
Please complete all fields in
red
before submitting form.
DISTRIBUTOR
LOCATION
TRACKING NUMBER
FAE:
Phone:
Ext:
Email:
Sales Person:
Phone:
Email:
CUSTOMER INFORMATION
Customer:
Address:
City:
State:
Zip:
Mfr Sales Person:
Phone:
Mfr FAE:
Phone:
DISTRIBUTOR ACCOUNT NUMBER
MANUFACTURER ACCOUNT NUMBER
PROJECT INFORMATION
Concept/Prototype/Win/Production
Status:
Prototype Date:
Project Name:
Units:
(Quantity)
Production Date:
(Expected or Actual)
Description:
(Application)
Project Engineer:
Phone:
Ext.:
Additional Engineer:
Phone:
Ext.:
Purchasing Contact
Phone:
Ext.:
MANUFACTURER AND PART NUMBER FOR REGISTRATION
Complete Line 1 before Submitting
Joint Visit Date:
Manufacturer
Part Number
R/A *
Description
A.S.P.
Qty/Sys.
Value/1st Yr. Prod.
Registration Level
L1
L2
L3
L4
* R=Registerable A=Associated
COMPETITION:
(Mfg/Past/Price/Issues)
Comments/Action Items: