1099 Distributorship Profile Form
Please complete the profile form below, and we will contact you to discuss distribution opportunities in your area.
Distributorship Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Principal Name
*
Principal Email
*
example@example.com
Principal Phone
*
-
Area Code
Phone Number
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
Surgeon Referral
Distributor Referral
Linkedin
Instagram
Google
Other
Submit
Should be Empty: