Collateral Request Form

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					                                                                                                          MCR#:
                                                                     Marketing Collateral                 Date:
                                                                       Request Form                       Page: 1


                                                             REQUESTED BY
                                                                                           Company:

Reason:

                                                                 SEND TO
Company:
Contact:
Address:
City, State/ Zip:
Telephone:

Brochures                                                         Quantity     Product Reference Guide                            Quantity
EX525ST
EP761
TX778W
TX1080
EW1610
HD65
HD71
HD80
HD806
HD81-LV                                                                        Reprints                                           Quantity
HD-3000
HD8200
HD8000-LV
DV11
Company Overview                                                               Miscellaneous                                      Quantity
Home Theater PRG                                                               Red Optoma Folders                                   20
Accessories PRG                                                                Banners




                                                                               Giveaways                                          Quantity




Packages will be mailed every Friday by UPS Ground only. If the materials are needed sooner, please specify the due date, provide your UPS or
Fed Ex Account #, indicating the type of service required and fill out the shipping request form.
Due Date:

Name of Mailing/Shipping Service

Account Number

Type of Shipping Service

Please Fax this form to 408-383-3702, Attention: Marketing Dept. or Email: lucyc@optoma.com
                                                       Shipping Request Form
Date                                      7/2/2009                                  Consignee
Shipper Company                                                                  Attention to
Other than Optoma                                                                    Address
Contact Name:                                                                  City, State/Zip
Address                                                                                   Tel
City, State/Zip                                                                           Fax
Tel                                                                           Business Hour
Fax                                                                         Shipping Method
Business Hour                                                      Additional Liability Cover
Actual Weight                                                      Third Party Collect acct. #
(Pallet) Dimensional                                                            Deliver Date:



           Model               Quantity                      Purpose                                  Serial Number




                   Note:


Terms & Conditions
1. Please indicate the due date on the request form.
2. Please indicate if additional liability coverage is needed.
3. Please submit to the Logistic Dept. by 2:00pm (require at least a 3-hour window before pick up).
4. Pick-up hours are according to pick-up location's business hours.
5. Please indicate if a return shipment is required.



Applicant (Print Name)                                                  Signature                               Date


                                                                 OPTOMA USE ONLY

Manager (Print Name)                                                    Signature                               Date


Director of Operation ( Print Name)                                     Signature                               Date