WIN MORE BUSINESS... when you recommend Black Box® products to your customers. With our Deal Registration Program, once approved, you are guaranteed to receive the largest discount Black Box extends to any reseller or integrator participating in Black Box’s standard reseller/integrator discount program at the time of your submission of this application. The discount will only be applicable to the opportunity described in this application. It provides the lowest Black Box price, and it’s yours! All you need to do is submit your completed Deal Registration Application for $25,000 or more for federal government opportunities, or $5000 or more for state & local government; small, medium, or large business; or K–12 and higher education opportunities of Black Box brand products (see form below). A decision will be provided within 72 hours.

Product lines include: • Adapters • Cables    – Category 5, 5e, 6, 6a, & 7    – Fiber    – VGA    – Custom • Cable Management • Digital Signage & Multimedia • Extenders • KVM Switches    – KVM over IP, too! • Patch Panels • Racks and Cabinets • Tools and Testers • Wallplates And more!

Need help specifying Black Box products? Talk to one of our dedicated Tech Support experts at 724-746-5500. They’re available 24/7.

Black Box Network Services Deal Registration Program — Commercial; Federal, State, & Local Government; K–12 and Higher Education Application Please submit this form along with the project details so that this opportunity can be officially registered to your company. Once the registration is received, Black Box will qualify it with the Partner and extend an exclusive discount to the reseller or integrator participating in Black Box’s standard channel discount program. All deal registrations must be approved by Black Box. Federal Deal Registration Applications are subject to a 21-day grace period. Because this registration is intended to protect our Partners’ efforts in promoting and specifying Black Box products, any BBDR Program Application received after an RFQ/RFP has been released will not be approved without prior consent from Black Box. NOTE: This Deal Registration Program applies to any sales opportunities to small, medium, or large businesses; federal, state, or local government; or K–12 and higher education of Black Box labeled products with an aggregate value of at least $25,000 or more for federal government opportunities, or $5000 or more for state & local government; small, medium, or large business; or K–12 and higher education opportunities (an “Eligible Opportunity”). The benefits of the Program cannot be combined with any other Black Box program or discount.

Your Information

Type of Deal:

Choose One...CommercialFederalState/Local GovEducation (K-12 or Higher Ed)

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Company Name:

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Customer Number:

City:

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State:

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Zip:

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First Name:

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Last Name:

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Contact Number:

E-mail Address:

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Phone:

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Your Customer/End User Information

Company Name:

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Contact Name:

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E-mail:

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Phone:

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Address 1:

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Address 2:

Address 3:

City:

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State:

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Zip:

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Project Information

Project Name:

Project Description:

Project Status:

Choose one...ConceptBudgetaryDesignPrototypeReady to Buy

If Federal Application, RFP/RFQ#:

Vertical Market:

Choose one...Banking, Financial, and LegalCorporateEducationState and Local GovernmentHealthcareHospitalityIndustrial/ManufacturingRetail

Are You Working with Anyone at Black Box?

YesNo

If Yes, Who?

Do You Require Pre-Sales Assistance from Black Box?

YesNo

Estimated Budget Approval Date:

Date When You Must Receive Black Box’s Price Quote:

Time:

Will Installation Services Be Needed?

Choose one...YesNoUndetermined

Black Box Product Information

Competitor Information (If Applicable)

Black Box Product / Part Number	Black Box Quantity	Competitor Name	Competitor Product / Part Number	Competitor Quantity	Competitor’s Price Per Unit

Make sure your total Deal Registration meets either the $5000 or $25,000 minimum. If you need more space, click here to download an addendum spreadsheet for a minimum of $5000 or more for state & local government; small, medium, or large business; or K–12 and higher education opportunities, or click here to download an addendum spreadsheet for a minimum of $25,000 for federal government opportunities, and attach to an e-mail to Marcy Kramer.

Who Provided a Price Quote for a Competing Solution?

Choose one...You, the ResellerDifferent ResellerManufacturer

Yes, I have read and agree to the terms and conditions of this deal registration.*

Thank you for registering this deal. Please send any additional project details to Marcy Kramer. You will receive a response in 72 hours. EXPIRATION: This registration expires 90 days from the approval date. Extensions and rollout exemptions may be requested.
CS&S-F-026 Rev6 (2/25/13)	Company Confidential