COMPANY NAME:
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| PLEASE GIVE US A BRIEF OVERVIEW OF YOUR COMPANY |
What is the name of your main contact?
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What are your core areas of business?
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Full address (include country and mailing code).
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Where is your corporate headquarters located (city and country)?
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| How many branch offices do you operate and where are they located?
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| Please list all of the geographic markets and/or countries into which you distribute products.
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| Please provide your web site address.
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| How many people (total) does your company employ?>
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| How many direct sales representatives does your company employ?
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| PLEASE DESCRIBE YOUR COMPANY ORGANIZATION |
Specify the management structure and number of marketing, administrative, technical & medically qualified personnel.
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PLEASE PROVIDE US WITH SOME FINANCIAL INFORMATION
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| Bank reference
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| Are you privately owned or publicly held? If publically held, please provide the exchange and your symbol. |
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Private
Public
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| Exchange & Symbol:
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| Credit Reference #1 |
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Credit Reference #2 |
| Company Name:
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Company Name:
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| Contact Name:
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Contact Name:
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| Address:
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Address:
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| Telephone:
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Telephone:
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| Fax:
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Fax:
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| E-mail:
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E-mail:
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| Annual Turnover (Gross Sales) in U.S. dollars (select one) |
| Under $500,000 |
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$2,000,000 - $5,000,000 |
| $500,000 - $1,000,000 |
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$5,000,000 - $10,000,000 |
| $1,000,000 - $2,000,000 |
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$10,000,000 + |
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