Simplified Purchase Program French

Please complete this form and follow all instructions carefully. This will ensure that the agreement will be programmed with the discount terms effective within 24 business hours of the form submission. If the form is incomplete the new discount terms will not take effect until the agreement is programmed.

Rep Information (Name & TY)*

Rep Name (First & Last) TY#

Rep Email

Parent Account (Acct # & Name)*

Verify the parent customer’s Legal Entity name and enter it into the form along with the account number.

Parent Acct # Parent Account Name

Customer Name & Job Title*

The name of the person who initiated the agreement and their title.

Name (First & Last) Job Title

Customer Email*

You must include the email address of the person with the authority to sign the agreement. They will receive a copy of this agreement via email and be asked to verify their acceptance of the terms.

Current Program Type*

Select program type customer is currently using.

Branch Account #'s

Please list all branches to be included on program. Use Acct #'s only NOT account names.

Select Payment Terms*

If the customer has been placed on COD by credit, you must select COD as the payment terms.

Full payment must be received by Batesville by the 15th of the month following delivery to be eligible for any prompt payment discount. If Customer chooses not to take a discount, payment must be received by the 15th of the second month following delivery.
Payment must be received by Batesville upon delivery (COD).

Casket Unit Goal Per Year

Please enter a number greater than or equal to 5.

Discount Available (Goal 5-25 units)*

Select one discount percentage. The discount range is based on the Casket Unit Goal Per Year.

Discount Available (Goal 26-75 units)*

Select one discount percentage. The discount range is based on the Casket Unit Goal Per Year.

Discount Available (Goal 76-175 units)*

Select one discount percentage. The discount range is based on the Casket Unit Goal Per Year.

Discount Available (Goal 175+ units)*

Select one discount percentage. The discount range is based on the Casket Unit Goal Per Year.

Hidden

Options % btwn 0-75

Hidden

Options % btwn 76-175

Hidden

Options % > 176

Rep Confirmation*

I agree that I have discussed the unit goal and discount percentage with the customer listed on this agreement.