Potential Supplier Form

Potential Supplier Form
Let Us Know If You're Interested

Google has purchased land in Botetourt County for a potential data center. The Roanoke Regional Partnership is collecting information from potential suppliers to provide to Google. Please fill out the information below, and we will pass it along to the company.
Customer Details:
Business Name*
Full Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
What industry/sector are you in?*
Please provide any relevant URLs
Any additional information you'd like to include?
Are you an investor with the Roanoke Regional Partnership?*

YesNo
Should be Empty:

Let Us Know If You're Interested