(*) Required fields
First Name
Last Name *
E-Mail *
Phone *
Company Name *
Your title/position *
Postal address, street *
Postal address, city *
Postal address, region
Postal address, country *
How many employees? *
European Agreement Number
(if applicable)
In which city is your main site? *
What is your main product line? *
How many years has it been in existence? *
Have your already worked for E. Leclerc? * Yes
No
Did you work for any other European retailer? * Yes
No
Do you employ subcontractors? * Yes - mainly
Yes - secondarily
No
Please describe the product(s)
you wish to submit to Siplec 		*
Explain what makes your product(s)
better than or different from others on the market 		*
  


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