CCR SPECIAL PRICING REQUEST FORM Email Address (required) Contact Name (required) Contact Number (required) Date Type of Request (required) MAPSourcewell RFP Issued? (If yes, please include a copy and any other documentation) YesNo Due Date to Dealer Requesting Dealer (required) Account Name (required) Account Location (required) Current Vendor (required) Award Type Single Order (Single order: Dealer will receive pricing for ONE time only) Estimated Order Timeframe Ongoing Orders (Multiple orders: Specify potential timeframe) Estimated Order Timeframe Revenue Potential (Sharp Equipment) Account Information Lease Term N/A36 Months48 Months60 MonthsOther If other, please specify Current or Estimated Volumes (For Sharp equipment requested) Black/White per month Color per month Pricing Request (required) Requested Pricing / Pricing Justification (This may include competitive pricing data, lease buyouts, maintenance, etc.) (REQUIRED) Equipment & Options (Please attach appropriate equipment configuration template.)
