Complete this form to give us a heads-up about your intended order. It alerts us to be on the lookout for your purchase, ensuring the free 5 Ft. Retail Rack comes with your qualifying order.

Your First Name: Ex. John

Your Last Name: Ex. Doe

Your Company Name: Ex. Fictional Corp

Your Job Title: Ex. Sales Manager

Your Company Email Address: Ex. john.doe@fictionalcorp.com

Your Phone Number: Ex. (123) 456-7890

Your Expected Purchase Date for $750+ of VGS™ Cable/Connectivity Products: Ex. 2024-04-01 (Planning to purchase $750+ of VGS™ Cable/Connectivity products on April 1st, 2024). The date you select is just an estimate to help us prepare; you are not obligated to order on that exact date.

How Do You Plan to Purchase $750+ of VGS™ Cable/Connectivity Products: Online via the Vericom Website Offline via my dedicated Vericom Representative Offline via email to the Vericom Sales Team Offline via phone call to the Vericom Sales Team N/A - Not Sure Yet

VGS™ Cable/Connectivity Products You're Interested In Purchasing: VGS™ Keystone JacksVGS™ FaceplatesVGS™ Patch PanelsVGS™ Copper Patch CablesVGS™ ToolsVGS™ LGX Fiber EnclosuresVGS™ LGX Fiber Adapter PanelsVGS™ Fiber Pigtail KitsVGS™ Fiber Patch CablesVGS™ Fiber AdaptersN/A - Not Sure Yet Note: Selecting specific VGS™ products or options here does not obligate you to those choices. This information simply helps us better understand your interests and how we can assist you with your qualifying purchase for the free retail rack promotion.

Any Additional Comments You May Have: Ex. I need help ensuring my order qualifies for the free retail rack promotion. Can someone guide me through the selection process? Thank you!

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