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Simplay Sales/Rep Order

Sales/Rep:

Customer:
Sales/Rep Name: Company Name:
Company Name: Customer Contact:
Phone: Phone:
Email: Email:

Simplay Items:

Check the items below that apply. Please indicate whether it's a lead or order.

Note: No commission will be paid without an active order form. All leads/orders will expire after 90 days.

Annual Membership






DUT Testing





Tools


Qty
 SPS
 CEC Explorer
 CEC Technology S/W & Eval Platform

Bill To (If Known):

Name:
Company:
Division/Dept:
Street:
City:
State:  
Country:  
Postal Code:
Phone:
Email:
Note:

Note: Volume discount available on tools for Distributers
5% discount @ 5-10 lot order
10% discount @ 11-15 lot order
15% discount @ 16+ lot order