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Special Pricing Request Form
Please provide as much information as possible using the form below.
We’ll get back to you as soon as possible!
Opportunity Type, please select from the dropdown box*
Select a Opportunity Type
Refresh – Teller
Refresh – Backcounter
New – Teller
New – Backcounter
New-RDC
Other
Partner Information
Customer Information
Company Name*
Select a Partner
Automated Business Solutions
BankSystems Marketing
Benchmark Technology Group
BLM Technologies DBA Teksetra
CashTech Currency
Computer Service Professionals Inc
Computer Services Inc
CrossCheck, Inc
Data Business Equipment, Inc.
Data Financial, Inc.
Deluxe
Fidelity Information Services LLC
Financial Systems & Equipment, Inc.
Financial Transmission Network, Inc.
Fiserv
Hydeman Company, Inc.
Innovative Business Solutions
InStream, LLC.
iStream
Jack Henry & Associates
Kristopher James Company
MHL Computer Products
MTS Software Solutions
New England Money Handling Systems, Inc.
Northwest Bank Technology
Other
Paystation, Inc.
SalesSource International
Secure Check Cashing, Inc
Soroc
Superior Press, Inc.
Technology Unlimited Inc.
Tempus Technologies
Tipton Banking Inc.
Unilink, LLC
United Tranzactions
Wanke & Associates
Company Name*
Email*
Email
Contact Name*
Contact Name
Other Partner
City
State
Phone
Opportunity Details
Competitive Bids
Target Date*
Canon
Model
Application Software
Epson
Model
Current Hardware
Panini
Model
Other
Model
Part Numbers & Timeline
Timeline
One Shipment
Roll out in stages
Item Category*
Select a Category
Scanner
Printer
Service - Extended Warranty
Service - Advanced Unit Replacement (AUR)
Other
Part # or product description*
Select a Part Number
157000-01
157000-02
157001-01
157001-02
157010-01
157010-02
158000-51
158000-52
158000-62
158000-71
158000-72
SSA1-65105-P20
SSM1-MICROELITE-NOIJ
SSP1-ELITE155
SSP1-ELITE75
SSP2200100-P20
SSX1-ELITE
SSX1-ELITE-FS
SSX1-MICROELITE-RNIJ
Item Description
Quantity*
Item Category
Select a Category
Scanner
Printer
Service - Extended Warranty
Service - Advanced Unit Replacement (AUR)
Other
Part # or product description
Select a Part Number
157000-01
157000-02
157001-01
157001-02
157010-01
157010-02
158000-51
158000-52
158000-62
158000-71
158000-72
SSA1-65105-P20
SSM1-MICROELITE-NOIJ
SSP1-ELITE155
SSP1-ELITE75
SSP2200100-P20
SSX1-ELITE
SSX1-ELITE-FS
SSX1-MICROELITE-RNIJ
Item Description
Quantity
Item Category
Select a Category
Scanner
Printer
Service - Extended Warranty
Service - Advanced Unit Replacement (AUR)
Other
Part # or product description
Select a Part Number
157000-01
157000-02
157001-01
157001-02
157010-01
157010-02
158000-51
158000-52
158000-62
158000-71
158000-72
SSA1-65105-P20
SSM1-MICROELITE-NOIJ
SSP1-ELITE155
SSP1-ELITE75
SSP2200100-P20
SSX1-ELITE
SSX1-ELITE-FS
SSX1-MICROELITE-RNIJ
Item Description
Quantity
Item Category
Select a Category
Scanner
Printer
Service - Extended Warranty
Service - Advanced Unit Replacement (AUR)
Other
Part # or product description
Select a Part Number
157000-01
157000-02
157001-01
157001-02
157010-01
157010-02
158000-51
158000-52
158000-62
158000-71
158000-72
SSA1-65105-P20
SSM1-MICROELITE-NOIJ
SSP1-ELITE155
SSP1-ELITE75
SSP2200100-P20
SSX1-ELITE
SSX1-ELITE-FS
SSX1-MICROELITE-RNIJ
Item Description
Quantity
Item Category
Select a Category
Scanner
Printer
Service - Extended Warranty
Service - Advanced Unit Replacement (AUR)
Other
Part # or product description
Select a Part Number
157000-01
157000-02
157001-01
157001-02
157010-01
157010-02
158000-51
158000-52
158000-62
158000-71
158000-72
SSA1-65105-P20
SSM1-MICROELITE-NOIJ
SSP1-ELITE155
SSP1-ELITE75
SSP2200100-P20
SSX1-ELITE
SSX1-ELITE-FS
SSX1-MICROELITE-RNIJ
Item Description
Quantity
Other Notes & Comments
