Price Change Request Form
Customer Account Number
*
If for ALL customer, just type ALL
Customer Name
*
Please specify the reason for the request.
*
Competitor Pricing
Acquiring new business
New Product Introduction
Other
Please Specify "Other"
Is your request to adjust pricing for the customer by
Specific prices for a list of parts (NET price)
A discount percentage off a specific list of parts
A discount off of an entire product line, vendor or node
Change Customer's entire pricing Matrix (ie Delta to Charlie)
Other
Product Price Request - NET Pricing
*
Product Price Request - Discount Pricing
*
Requested Vendor Pricing Adjustment
*
Customer's Current Pricing Matrix
*
Please Select
Alpha
Beta
Charlie
Delta
Igloo
Requested Pricing Matrix
*
Please Select
Alpha
Beta
Charlie
Delta
Igloo
Do you anticipate that the customer will purchase more than $100,000 per year?
*
Please Select
Yes
No
Please explain the reason for your request to change customer's pricing matrix.
*
Please elaborate on your pricing request "other"
*
Please provide a few JS part numbers that will be impacted by your pricing change so that we can review to make sure that we have accomplished your request.
*
If you select NET pricing, you MUST select an expiration date
*
-
Month
-
Day
Year
Date
Anticipated Sales Impact for Customer across all lines:
*
0-$1,000
$1,001 - $5,000
$5,001-$15,000
$15,001-$50,000
$50,001 - $75,000
$75,001+
Will this anticipated sales increase need to be addressed by ordering additional product to meet the increase in demand? Please identify specific products or product lines that need to be reviewed
*
Supporting Documentation (competitor quotes, etc)
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Name
*
First Name
Last Name
Email
*
example@example.com
Submit
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