Distributor application form - cardio DISTRIBUTOR APPLICATION FORM - CARDIOKindly complete this application for Rumex to consider your company as a distributor. Please, try to answer all questions, it will not take much time. Question Title * 1. Company name Question Title * 2. Company contact details (address, city, state, country, telephone, e-mail, website) Question Title * 3. Country profile Population, mln Total cardio surgeries Question Title * 4. Company sales per year <$100,000 $100,000-500,000 $500,000-1 million >1 million Question Title * 5. Quantity of personnel in your company total salesmen administrative Question Title * 6. How many years is your company in business? Question Title * 7. Contacts of key personnel (name, job position, experience is sales of ophthalmic products) Question Title * 8. Territory/regions covered by your company Question Title * 9. Other producers/distributors represented in your region/territory os sales (company name(s) Question Title * 10. What is your primary method of customer contact? phone call personal sales call direct mail trade show e-mail personal visit Question Title * 11. Do you visit manufacturers production sites? regularly occasionally never Question Title * 12. Do you exhibit at medical meetings/congresses? yes no If yes, kindly name them Question Title * 13. Does your company organize surgeon workshops? yes no If yes, kindly describe Question Title * 14. Do you make direct mailings to customers? yes no Question Title * 15. Do you submit regular sales reports and forecasts to manufacturers you represent? yes no Question Title * 16. How do you advertise? Printed ads (magazines) Company website Internet resources Social networks (facebook, twitter, other) Mass media (TV, radio) If any, name them Question Title * 17. What is your normal inventory stocking policy? Question Title * 18. Bank references (bank name, address, account information) Question Title * 19. What are the specific characteristics of the cardio instruments market in your country? Question Title * 20. What are the major meetings/congresses you would attend and exhibit in your territory? Question Title * 21. Do you participate in tenders? What are the approximate delivery terms? Question Title * 22. What are the most popular brands in your country? Question Title * 23. Are any cardio instruments produced in your county? yes no If yes,kindly name companies Question Title * 24. What types of surgeries are popular (and/or becoming popular) in your country? Question Title * 25. What are the main reasons and purpose for your company to become a distributor of Rumex products? Question Title * 26. Would you consider opening a special division for the Rumex products and hire a dedicated clinical specialist for Rumex products? Question Title * 27. How many customers that use surgical instruments do you have? Private clinics State clinics Question Title * 28. How many of your customers use Rumex products? Private clinics State clinics Question Title * 29. What customs duty rates must you pay to import items from Rumex? Products, % Literature, % Question Title * 30. What is your yearly sales expectation for Rumex products? Forceps, $ Needle Holders, $ Clamps, $ Scissors, $ VATS and MIS, $ Miscellaneous Instruments, $ Instrument care, $ TOTAL, $ Thank you for your time! In hope for future partnership, your Rumex team! Done