Inovus New Distributor Application Form
Assessment criteria for potential Inovus Medical distribution partners
Name of your company
*
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
*
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Company Organisation
*
Proprietorship
Corporation
Partnership
Limited Liability
Date organised
*
-
Month
-
Day
Year
Date
Principal officer name #1
*
First Name
Last Name
Back
Next
Financial Information
Sales for last year
We will reach out to ask that you supply last years financial accounts, are you happy to supply these to us?
*
Yes
No
Sales for current year
Sales forecast for next year
Your company's paid in capital
Bank name
Bank Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business references #1
Include name, address, and person to contact
Business references #2
Include name, address, and person to contact
Back
Next
Marketing Information
Which of the following describes you
Representative
Dealer
Distributor
Describe the types of products sold, including brand name
Describe the hospital departments/organisations your sales managers visit regularly (e.g. general surgery, O&G, simulation centres, universities etc)
List conferences you attend on a regular basis (scientific congresses, medical device congresses etc)
List at least 10 reference sites (Hospitals or Universities) that you have supplied product to:
How long have you been in business?
Years
Are you currently an agent or representative of any other company which manufactures products similar to our product?
Yes
No
If 'Yes' please name companies below
Do you have any objections to us contacting any such principal?
Yes
No
Add any comments here
What is your geographical sales area for the above listed products?
Projected sales of Inovus products for next fiscal year
Will you maintain products for demonstration in your country?
Yes
No
Add any comments here
Please describe your product display facility and/or product demonstration procedures
Back
Next
Technical
Do you own your OWN service facility/warehouse for stocking?
*
Yes
No
If 'No' do you contract with an outside service workshop?
Yes
No
If 'Yes' give the name and address of outside warehouse/workshop
If you do not have a service facility/stocking warehouse, are you willing to establish one for support of products?
Yes
No
If 'Yes' when?
Add any comments here
We may ask for additional documentation during the application process, are you happy for a representative to reach out for this information?
Yes
No
Submit
Should be Empty: