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		First Name
Address		Last Name
ZIP		Title
Location		Position
Country		Phone direct
Phone		Mobile
Fax		Fax direct
Website		Email direct
Year founded

Number of Employees:
Total
Field Sales
Inside Sales
Service
Number of Locations

Which territory do you cover?

What were your annual sales in the last year(EUR)?
< 2'000'000
< 5'000'000
< 10'000'000
> 10'000'000
Which customer categories do you generate business from?
Government
Hospital
Private Hospital
Service companies
Others
Which respiratory/ventilation products do you represent(brand/origin)?

Which testing equipment products do you represent(brand/origin)?

What other companies and products do you represent?

Are you offering calibration services on ventilation/anesthesia devices?
Ventilation
Anesthesia
None
Are testing/calibration of medical devices required by local laws/regulations?

Is the local market demanding medical air compressors?

What brands/models are mainly supplied?

What share of your business is based on tenders?

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

Do you advertise? Which publications?

Which tradeshow(s) do you attend as an exhibitor?

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