SMART HOME FORM

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Vendor Name *

Contact Name *

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Last

Vendor Address *

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City

State

Zip Code

Country

Email *

Phone Number *

Name of Device Being Considered by PC Richard Smart Home Display *

Model # of device *

Do you wish to power this device at retail? *

YES NO

Do you have a device for display development that is either consumer grade or factory modified that you can send to us? *

Yes No

Do you have a data or specification sheet you can send us on this product? *

Yes No

If yes, how soon can you send to the address below? *

In-Store Experience
Attn: Adam Silverstein
37 Franklin Street
Westport, CT 06880

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PC Richard & Son Smart Home Form