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 we can ship your gift quickly and to the correct location after placing 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 $250+ of Surplus Products: Ex. 2024-04-01 (Planning to purchase $250+ of Surplus 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 $250+ of Surplus 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

Personal Gift You Aim to Receive With Your Purchase $250+ of Surplus Products: Nest Mini ($250-$499 Purchase) Nest Hub ($500-$999 Purchase) LG UHD 43" TV ($1,000+ Purchase) N/A - Not Sure Yet Note: Selecting a specific gift here does not obligate you to that choice. This information simply helps us better understand your interests and how we can assist you with your qualifying purchase for the personal gift.

Mailing Address Of Where You Want Your Personal Gift Delivered (Must Be In U.S. / Unable To Ship To PO Boxes): Ex. John Doe 123 Fictional Street Downingtown, Pennsylvania 19335 United States

Any Additional Comments You May Have: Ex. I need help ensuring my order qualifies for the free LG UHD 43" TV. Can someone guide me through the selection process? Thank you!

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