Customer declaration form

End Customer Information

Registered business entity name    ____________
Registered business address    ____________
contact person    ____________
contact person position    ____________
Installation address    ____________
Selling through dealer?
Yes
No

Dealer Information

Dealer name    ____________
address    ____________
contact person    ____________
contact person position    ____________
Selling through next layer dealer?
Yes
No

The next layer dealer information

Dealer name    ____________
address    ____________
contact person    ____________
contact person position    ____________
Project  Information
Project basic situation    ____________
Camera model needed    ____________
12 months volume    ____________
 Special support to customer
Camera on loan    ____________
Quantity    ____________
Loan date    ____________
Software support    ____________
Support date    ____________
Tech support    ____________
support start date    ____________
Special history
    ____________
Demand Forecasting Estimate
1st delivery quantity    ____________
1st delivery date    ____________
Projected completion date    ____________

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