If you are interested in dealership, please fill in the following
questionnaire form, and send it back to us:

Contact form for interested distribution partners and/ or OEM's


*Please fill in all the blocks!

Company name*	Mrs./Mr.
First name(s)*	Surname*
Postal code*	City/town*
Street address*	Telephone*
Fax	E-mail*
Company's website*
Business Overview
What kind of products do you supply and support?*
Medical IT
X-ray equipment
CR
DR
Kind of partnership*
Distribiution partner
OEM
Business area*
Human medicine
Veterinary medicine
Human and veterinary medicine
The number of your existing clients*:
The number of sales staff*:
The number of technical support staff*:
Comments/ questions:
Please call me.