Promotion Registration Form

Today's Date:

Check one or both as appropriate:
I am first-time registering for the program
I am registering a qualifying sale

To first-time register or to register a qualifying sale, you must provide the following information:

Dealer Name:
Dealer Address:
 
Salesman Name:
Mailing Address
(All-In spiffs and chips will be sent to this address)
Phone Number:
Email Address:

If registering a qualifying sale, complete the information below:

DP Projectors sold: Choose Projector Enter Quantity
Model 1
Model 2
Model 3
DP Invoice Number  
DP Invoice Date  
DP Invoice Value  
Spiff Recipients social security #