Company Name*
 
 
 
Civic number*
 
 
Street name*
 
 
 
City
 
 
Zip/Post Code
 
 
 
Country*
 
 
 
 
State*
 
 
 
 
Province*
 
 
 
 
 
 
First name (contact person)*
 
 
Last name (contact person)*
 
 
 
Email*
 
 
 
 
Phone number*
 
 
 
 
Language*
 
 
 
 
Website or main social media page*
 
 
 
 
Lallemand Product Range * 
 
Bacteria for Brewing
 
 
 
Brewing Yeast
 
 
 
Enzymes
 
 
 
Home Wine Yeast
 
 
 
Laboratory Media
 
 
 
Nutrients
 
 
 
Process Aids
 
 
 
Sensory Kits
 
 
 
Explicit consent 
 
 
I want to receive advice and communications from Lallemand Brewing by email.
 
 
 
I accept to be contacted by a Lallemand representative.
 
 
 
 
 
 
 
 
 
You are / Retail
 
 
 
 
You are