We would like to Pilot Test Forum^TM in our supply chain.

My Company:      

Address:             

Contact Person:  

Email:                 

Tel.                     

Fax:                    

Distributor(s) / C&FA(s) nominated for Pilot Test

Company:           

Address:             

Contact Person:  

Email:                 

Tel.                     

Fax:                    

Company:           

Address:             

Contact Person:  

Email:                 

Tel.                     

Fax:                    

Pilot Test Can Commence From:     (MM/DD/YYYY)

The parties Distributor(s) / C&FA(s) nominated for the Pilot Test will have the necessary system resources.