Form – NVC Greggs Promo Site

First Name *

Last Name *

Company *

Email Address *

Telephone Number *

Value of claim *

Wholesaler Info

Let us know where you made your purchase

NVC Distributor *

Branch Location (City/Town) *

Branch Manager Email Address

Attach Invoice *

File name:

File size:

Terms Checkbox *

Marketing Checkbox

By submitting your details for this promotion you agree to NVC storing your details for marketing purposes.

Do you usually buy NVC Lighting products? *