EXPLORE A FORGE

SATELLITE OPPORTUNITY

Interested in developing a deeper strategic relationship with Forge RX? Tell us about your business and your vision.

Satellite Application Sign-Up

Business Name *

Owner/Primary Contact *

Email *

Phone *

Website *

Location *

Years in Business *

Why are you interested in developing a relationship with Forge RX? *

How did you hear about Forge-RX? *

Do you already have a relationship with someone at Forge RX? *

Yes

No

If yes: Who is your primary Forge RX contact? *

A Satellite relationship may involve business, financial, operational, legal and compliance discussions before any agreement is offered. *

A Satellite relationship may involve business, financial, operational, legal and compliance discussions before any agreement is offered.

Is there anything else you would like the Forge RX team to know?

I understand that submitting this application does not create a partnership, affiliate relationship, franchise, licensing arrangement, or other business relationship with Forge RX. Any potential Satellite relationship is subject to further evaluation, due diligence, legal/compliance review, and a sepIs there anything else you would like the Forge RX team to know?arate written agreement.

I certify that the information provided in this application is accurate to the best of my knowledge.

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678-300-1906

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EXPLORE A FORGE

SATELLITE OPPORTUNITY

Satellite Application Sign-Up

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