1099 Distributorship Profile Form
Please complete the profile form below, and we will contact you to discuss distribution opportunities in your area.
Street Address Line 2
State / Province
Postal / Zip Code
How many W2 Sales Reps are a part of your sales organization?
How many 1099 Sales Reps are a part of your sales organization?
Call Points: What surgeon specialties do you routinely call on?
Description of Geography Covered
Which Lines Do You Currently Carry?
Do you carry any products that would be competitive (please list all):
How Did You Hear About Us?
Regional Manager Referral
Should be Empty: