National Accounts Info Request Form

Salutation:
First Name:
Last Name:
Title:
Company:
Address 1:
Address 2:
City:
State:
Zip:
Phone Number:
E-mail:
Please Select a Category:
What MRO commodities are in scope?
Annual spend on electrical products?
Total number of plants/locations?
Do you have a Rockwell Automation (Allen-Bradley) installed base?
Do you have a national electrical agreement in place?
If yes, who is your national electrical agreement with?
Goals and objectives when considering a program (check all that apply):
Other services you'd like (e.g., summary billing, customized reports, vendor managed inventory)? Please specify:
General comments: