Application form for partnership request

We want to thank you for your interest towards Maman Kangourou. Complete this form and we will answer you as soon as possible.

Company information
Gender
 Male   Female
Society *

First Name *

Last Name *

Function *

E-mail address *

Confirm you E-mail address *

Address *

City *

Country *

State/Province *

Postal Code / Zip *

Telephone *

Years active *

URL of web site *

Activity section *
  •  Boutique
  •  Organization / Foundation
  •  Health
  •  Wholesale distributor
  •  Magazine/Newspaper
  •  Other:   

Subject of your request of a partnership: *