Customer Profile

MedEquip Depot Customer Profile Form
About 2-3 min. to complete

Thank you so much for taking the time to fill out your customer profile! The information you provide will assist us in designing a customized product and service offering for you facility. Please take note of the coupon code which will appear on the Thank You page and enjoy $10 off your next order! Thank you and we look forward to serving you!

Which are the most popular brands you purchase?*

	Purchase from MedEquip	Purchase from MedEquip and other Vendors	Purchase from other vendors	Do not currently purchase but I am interested	Do not currently purchase and I am not interested
Allied Healthcare
ArjoHuntleigh
Cardiac Science
CareFusion
Clinton Industries
Conmed
Cooper Surgical
Covidien

Which are the most popular brands you purchase?*

	Purchase from MedEquip	Purchase from MedEquip and other Vendors	Purchase from other vendors	Do not currently purchase but I am interested	Do not currently purchase and I am not interested
Criticare
Ethicon
GE Healthcare
Kendall (Covidien)
LabStrong
Maquet
Masimo
Maxtec
Midmark
Nellcor (Covidien)
Ohmeda / Datex Ohmeda

Which are the most popular brands you purchase?*

	Purchase from MedEquip	Purchase from MedEquip and other Vendors	Purchase from other vendors	Do not currently purchase but I am interested	Do not currently purchase and I am not interested
Philips
Precision Medical
Shiller
Sigma Aldrich
Spacelabs
Summit Doppler
Supermax
Welch Allyn
Zoll Medical

Brands (Part 4)
Other brand I purchase:
Other brand I purchase:
Other brand I purchase:
Were you aware that we carry over 1300 brands?*

YesNo
What would persuade you to consider our products and services, if you currently buy from a different supplier?*

Lower PricesPromotionsFaster Delivery TimesBetter Follow-up on OrdersOur syringe donation program (1 for each product we sell)

What types of promotions do you respond best to?*

	Very Important To Me	Somewhat Important	Not Important
Free shipping
% off order over a certain amount
$ amount off order over a certain amount
% off order for being a frequent buyer
$ amount off order for being a frequent buyer
Holiday coupons

Please rank our website along the following characteristics:*

	Excellent	Average	Poor
Ease of finding products
Availability of products
Ease of creating account
Ease of checkout
Automatic Status Updates
Availability of payment methods

MedEquip Depot Customer Profile Form