For Distributors - Submit Your Connect to Confidence Request

Connect to Confidence Program - Distributor Submission

Please provide as much detail as possible. All field are required.

Please Select One: *

I am a current CTC Authorized Distributor looking to access this promotion on behalf of a customer

I am not currently a CTC Authorized Distributor

Customer Company Name *

Brief Description of Customer Company *

Customer Company Address *

Customer Application Where CTC Products Will Be Used *

Your First and Last Name *

Your Title *

Your Email Address *

Your Company Name *

Your Company Location Address *

Competitive Part Numbers *

Please list the competitor's complete part number for each product in the cordset, along with a description of each part.

Competitive Part Issues *

Please list the competitor's complete part number for each product in the cordset, along with an explanation of the issue(s).

Competitive Price and Date of Purchase *

Please list the competitor's complete part number for each product in the cordset, along with the price and date of purchase.

Desired Replacement Parts *

Please list the desired replacement CTC part number for each item in your cordset. If not known/no preference, please enter N/A.

How Did You Hear About The Connect To Confidence Program? *

Social Media

Search Engine

Email

Word of Mouth

Other

Please List: *