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 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 State ZIP Code
Company 1 Phone*
Company 2 Contact
Company 2 Address
Street Address Address Line 2 City State ZIP Code
Company 2 Phone

BUSINESS OPPORTUNITIES

Authorized Distributor Application

Requested Territory

Present Channels of Distribution

Products Presently Distributed

Competitors

Customs

Marketing & Promotion

References