Channel Partner Name *
Your Name *
Your Email *
Your Phone Number *
Prospect Company Name *
Prospect Contact Name *
Prospect Contact Title *
Prospect Contact Email *
Subject Partner Special Pricing Request Submission Form
Products: If you are not requesting a special price for a product, please enter "0" for both QTY and Requested Price
HX402E (2 FXS Ports) List Price: $98.50 QTY: *
Requested Price Each *: $
HX404E (4 FXS Ports) List Price: $120.00 QTY: *
HX422E (2 FXS/2FXO) $ 130.00 QTY *: $
MX8A-8S (8 FXS Ports) $270.00 QTY *:
Detailed Special Price Request Justification:
