Company Name:
Industry/Interest:
Location(s) of Operation:
Contact Person: Position: Phone Number: Email Address:
Type of Products: Volume of Distribution: Preferred Distribution Regions: Specific Distribution Challenges/Requirements:
How did you hear about Alpha Centauri? Any specific goals or expectations from the distribution partnership:
Preferred mode of initial communication: EmailPhone call
I confirm that the provided information is accurate and authorize Alpha Centauri to contact me regarding this distribution inquiry.
