WID Listing Form 2023 – Distributors

To ensure that your company will be listed, please complete this form by 30 August 2022

Please add the contact details that you wish to have listed in the 2023 Australian & New Zealand Wine Industry Directory.

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Distributor Name

Distributor Name*

Head Office Contact Details

Address*
Do you allow us to include your contact details on the purchasable spreadsheet database for Third Party usage?

Interstate/New Zealand Branch Office Contact Details

List up to six interstate and/or New Zealand branch office addresses, phone and fax numbers.

Branch Address A

Address

Branch Address B

Address

Branch Address C

Address

Branch Address D

Address

Branch Address E

Address

Branch Address F

Address

Key Personnel

Please indicate the name and title of key person

Agencies

Submitter Information

Please provide your details in case we need to contact you regarding your listing in the Directory. This information will not be published in the Directory.