Haydon Rebate Request Form

Salesperson Requestor Name*

Salesperson Requestor Company*

Salesperson Requestor Email*

Customer Full LEGAL Name*

Minimum purchase of $150,000 is required within Term, will this customer meet this minimum?*

Select

I’d like to request an exception*

Please provide the address of your Principal Office or Division Headquarters below.

Address*

City*

State*

Select

Zip Code*

Are Payment Terms Changing?*

Yes

No

What Are the New Payment Terms?*

Is this a FLAT rebate or TIERED?*

Flat

Tiered

Please Select Your Flat Percentage*

%

Please outline net sales tiers and corresponding percentages.*

Termination Date (Standard Term is January 1 through December 31)*

Products INCLUDED [select all that apply]*

H-STRUT® Metal Framing

H-STRUT® Hardware/Fittings

H-BLOCK® Rooftop Support System

Baseboard Heating

Products EXCLUDED [select all that apply]*

H-STRUT® Metal Framing

H-STRUT® Hardware/Fittings

H-BLOCK® Rooftop Support System

Baseboard Heating

Customer Affiliates & Locations INCLUDED:*

Customer Affiliates & Locations EXCLUDED:

Any Other Notes?

Customer Signer Full Name *

Customer Signer Title *

Customer Signer Email *

Upload Supporting Documents

Attach relevant documents such as division/location listings, customer terms, customer agreements, and more.

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