Client Information
Client Number:
Dealership Name:
Contact Name:
Phone Number:
Fax Number:
*
Email Address:
(Your confirmation will be sent to this address)
* Please list the fax number for the person at the dealership that will execute the Contract Amendment, and their name (if different from the Contact Name above).
POWER Workstation
POWER Workstation should be requested by location. Please specify, by entering the
quantity in the appropriate spaces provided below, if any of the Total POWER
Workstation(s) you are requesting are for use with a POWER Server or on CPD 2000Net
Equipment (leave these fields blank if you are not 100% certain).
Total POWER
Workstation(s) Requested (Qty)
POWER Server? (Qty)
CPD 2000Net? (Qty)
Branch Number
Branch Name
Comments: