FOR END USERS:
SUBMIT YOUR CONNECT TO CONFIDENCE REQUEST

Please review program information and participation guidelines prior to completing the form.

Connect to Confidence Program - End User Submission

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

First and Last Name *

Your Title *

Email Address *

Company Name *

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 the 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 put N/A

How did you hear about the Connect to Confidence Program *

Social Media

Search Engine

Word of Mouth

Other