Request for Personnalized Support

By completing this form, you are asking to receive personalized telephone support to find the best resources available in your area.

First name*

Last name*

Name of Enterprise*

Quebec enterprise number (NEQ)*

(enter N/A if starting)

Region*

E-mail address*

Phone number*

What is your main production?*

Other production:

What is your status in the company?*

Owner

Co-owner

I have no shares in the company

Age*

Are you an Agricultrices du Québec member?*

Yes

What are your needs and objectives, in registering for the personalized support service with Dimension E? (short answer)*