ACCESS TO SELLIGENT EXTRANET SITE

IMPORTANT NOTICE: Selligent limits the access to its extranet to partners and customers who have a signed contract with Selligent. After validation of this request form, a temporary access may be granted to you if your partner/account manager agrees to do so.

1. Please take some time to fill in the information in the form provided below. Once your form is processed, a Selligent representative will contact you.

What is your relationship to Selligent?

Customer	Partner	Prospect
Investor	Student	Press
Analyst

The following fields are mandatory:

Details

First name:

Last name:

Company:

Activity sector:

E-mail:

Phone:

Sex : Male Female

Job title:

Postcode:

County:

Country:

Language:

How did you hear about us?

Search engine	Advertising	Press
Tradeshow	Customer	Supplier
Partner

2. Click on the Send button to process your request.

Selligent