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AQUOS D62 Sales Acceleration
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Short Description: Please complete this Claim Form and mail or fax to Sharp AQUOS D62 Sales Acceleration Program Headquarters with. corresponding copies of sales receipts ...
Content Inside: AQUOS D62 Sales Acceleration Claim Form Eligible Dates: October 1, 2006 November 30, 2006 Please complete this Claim Form and mail or fax to Sharp AQUOS D62 Sales Acceleration Program Headquarters with corresponding copies of sales receipts and/or customer invoice. Sales receipts and/or invoices for all sales listed must accompany the Claim Form. Checks will be mailed 4-6 weeks after receipt of Claim Form and audit completion. Mail: Sharp AQUOS D62 Sales Acceleration OR Fax: 1-800-949-0251 Program Headquarters Inquiries: 1-800-938-8728 PO Box 42012 Hazelwood, MO 63042-1012 RETAIL STORE INFORMATION Store Name ____________________________________________________________________________ Store # ________________________ Address _______________________________________________________________________________________________________________ City _______________________________________________ ST _______________ ZIP __________________ Phone ( _________ ) ______________ ________________ RETAIL SALES REPRESENTATIVE INFORMATION Salesperson's Name ________________________________________________________ Salesperson's SSN # ________________________ Shipping Address ______________________________________________________________________________________________________ City _______________________________________________ ST _______________ ZIP __________________ Phone ( _________ ) ______________ ________________ Email Address ______________________________________________________ Manager's Signature (required) ____________________________________________________________________ ELIGIBLE MODEL INFORMATION SELECT THE ELIGIBLE MODEL: SELECT THE ELIGIBLE MODEL: I $100.00 LC-46D62U I $125.00 LC-52D62U I $100.00 LC-46D62U I $125.00 LC-52D62U Customer Name _________________________________________________ Customer Name _________________________________________________ Customer Address _______________________________________________ Customer Address _______________________________________________ City _____________________________ ST _____ ZIP _______________ City _____________________________ ST _____ ZIP _______________ Customer Phone # ( _______ ) _____________ ______________ Customer Phone # ( _______ ) _____________ ______________ Date Of Sale _____________ / _____________ / ______________ Date Of Sale _____________ / _____________ / ______________ Sale Price $ ___________________ Store Invoice # __________________ Sale Price $ ___________________ Store Invoice # __________________ Serial # _______________________ Serial # _______________________ SELECT THE ELIGIBLE MODEL: SELECT THE ELIGIBLE MODEL: I $100.00 LC-46D62U I $125.00 LC-52D62U I $100.00 LC-46D62U I $125.00 LC-52D62U Customer Name _________________________________________________ Customer Name _________________________________________________ Customer Address _______________________________________________ Customer Address _______________________________________________ City _____________________________ ST _____ ZIP _______________ City _____________________________ ST _____ ZIP _______________ Customer Phone # ( _______ ) _____________ ______________ Customer Phone # ( _______ ) _____________ ______________ Date Of Sale _____________ / _____________ / ______________ Date Of Sale _____________ / _____________ / ______________ Sale Price $ ___________________ Store Invoice # __________________ Sale Price $ ___________________ Store Invoice # __________________ Serial # _______________________ Serial # _______________________
