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BUSINESS OPPORTUNITIES
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BUSINESS OPPORTUNITIES
Authorized Distributor Application
The below Application Form is designed to provide us with valuable information about your company, of which we are hopeful and poised at the potential for a business relationship.
Company Name
*
Title
*
Name
*
Phone
*
Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
*
Fax
Website
Requested Territory
Country
*
Region
*
Major City
*
Present Channels of Distribution
Whom do you presently sell to, or are qualified to sell to?
*
Select All
Dentists
Doctors
Other
Products Presently Distributed
What products do you presently distribute? Please include U.S. companies if any.
*
Number of Employees
*
Annual Sales Volume
*
Number of Sales Representatives
*
Competitors
Who are your largest competitors, how you do you rank in size, and what are competitive differences?*
*
Customs
Are you familiar with all the customs and tax regulations pertaining to the territory?*
Yes
No
Are there any special government registrations required of Osseofuse products before you can import them into your country? Are you able to comply with these requirements?*
*
Marketing & Promotion
Do you have your own resources for translating and adapting basic marketing materials such as literature for your own markets? It is our expectation that distributors produce marketing materials in the language(s) of their own country/territory.*
Yes
No
References
Company 1 Name
*
Company 1 Contact
*
Company 1 Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Company 1 Phone
*
Company 2 Contact
Company 2 Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Company 2 Phone
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