Rep First Name
Rep Last Name
Rep Email
Rep Phone Number
Preferred Distributor Ingram Micro TDSynnex AB Distributing Others Multiple
End User: School, District or Company Name
End User: Industry Education Corporate / Business Government Healthcare Other
End User: First Name
End User: Last Name
Phone Number
End User: Email
End User: Street Address
Country United States Canada Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d’Ivoire Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Viet Nam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
End User: State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Canadian Province Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nunavut Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon
End User: Postal Code
What product are you interested in? iPad Cases MacBook Cases Chromebook Cases Other Tablet Cases Other Laptop Cases Headphones / Headsets iPad Keyboards iPad Cable-Free Charging Sleeves & Bags
iPad Device Types iPad 5th - 6th Gen iPad 7th - 9th Gen iPad 10th Gen iPad Mini 1st - 4th Gen iPad Mini 5th - 6th Gen iPad Air 3rd Gen iPad Air 4th - 5th Gen iPad Pro (12.9-inch) 1st - 6th Gen iPad Pro (9.7-inch) iPad Pro (10.5-inch) iPad Pro 11-inch 1st - 4th Gen
MacBook Device Types MacBook Pro 14-in. (2021) MacBook Pro 16-in. (2021) MacBook Air (M2, 2022) MacBook Air (M1, 2020) MacBook Air (Retina, 2020) MacBook Air (2017) MacBook Pro 13-in. (M2, 2022) MacBook Pro 13-in. (M1, 2020) MacBook Pro 13-in. (2020, two ports) MacBook Pro 13-in. (2016, two ports) MacBook Pro 13-in. (2020, four ports) MacBook Pro 16-in. (2019)
Device Brand (Acer, Asus, Dell, Lenovo, HP, Others) Acer Asus Dell HP Lenovo Other Brand
Audio Device Model Headphones with Mic (3.5MM Jack) Headphone (3.5MM Jack/No Mic) Headphones with Mic (USB)
Specific Device Model
Quantity 100 - 499 500 - 1,499 1,500 - 4,999 5,000+
Expected Close Date ASAP < 5 months 6- 12 months 1 year +
Additional info (name of Sales Rep currently working with if applicable, specific quantity, products/SKU’s, roll-out/one-time buy, competitive information)
Samples Needed? Yes No
Pilot Program? Yes No
Have you purchased Brenthaven products before? Yes No Not Sure
Yes, I agree with the terms and conditions
Comments
By submitting your Deal Registration, you agree with the terms and conditions.