Fillable 3685628 Vive Sample Kit Form Vive Sample Kit Form

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3685628 Vive Sample Kit Form Vive Sample Kit Form

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© 2020 Lutron Electronics Co., Inc. P/N 368-5628 REV A
Vive sample kit form
Please fill out the form below for each “Farmer” electrical contractor you wish to give a Vive sample
kit to. All information requested must be completed in full for kits to be distributed.
Send this completed sheet to cwp@lutron.com with "Vive sample kit" in the subject line.
CMD Name: _____________________________________________________ Phone Number: __________________________________________________
Address: ___________________________________________________________________________________________________________________________________________
City: _________________________________________________________________ State: ___________________________________________ Zip: _____________________
EC firm name EC name EC email address
EC phone number
The Lutron logo, the Vive logo, Lutron, and Vive are trademarks or registered trademarks of Lutron Electronics Co., Inc., in the U.S.
and/or other countries.
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3685628 Vive Sample Kit Form Vive Sample Kit Form

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Completed 31 May 2020

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