Business Partner Application Form

Becoming an imtmedical sales partner will increase your opportunities in the future. We would like to invite you to
give us an idea about your key markets and organization.

Apply to become an imtmedical sales partner by filling in the business partner application form below:


Company		Fax
Year Founded		Number of Employees
First Name		Last Name
Title		Position
Email		Website
Street		Number
City		Zip Code
Country
Phone

How would you categorize your company?
Reseller	Manufacturer	Independent
Which customer categories do you generate business from?
End user	Dealers	Government	Others
What were your annual sales in the last year? (EUR)

How many sales people (inside sales / field sales) are in your organization?

How many locations does your company have?

What product categories does your company represent?
Homecare ventilators	ICU ventilators	Testing device	Accessories
Which of the following products would your company like to sell?
ventilators	Biomedical Testing Devices	Medical Air Compressors	Test Lungs
Which of the following ventilation products does your company currently sell?
Resmed/Saime	Respironics	GE	Covidien
Others:
What is the potential market for ventilators in your area? (EUR)

What other companies and products do you represent?
Company 1
Company 2
Company 3
What tradeshow(s) did you attend recently as an exhibitor?

Do you advertise? Which publications?

Do you have a demo area where you show your products?

Are you willing to buy a demo unit to install at your facility?
Yes	No

Thank you for your interest! You will be contacted as soon as possible