Distributors - SpineCraft

Ttle

Name

First Last

Company

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Fax

Website

Describe your company ownership/structure.

What territory does your distributorship currently cover?

Do you currently sell to spine surgeons?

Yes

If yes, approximately for how many years have you sold to spine surgeons?

If yes, how many spine surgeons do you actively sell to at this time?

How many hospitals do you sell to at this time?

What is your current hospital/end-user pricing in the sectors below for the primary spine implant categories (e.g. pedicle screws, MIS screws, MIS screws with integrated extended tabs, cervical cages, DLIF cages, etc.)?
Enter "N/A" if not applicable.

Government/Public Hospitals and Tenders

Teaching Hospitals

Private

Please list which other spine products you currently represent and duration represented.

What was your sales volume during the last calendar year?
Enter "N/A" if not applicable.

Government/Public Hospitals and Tenders

Teaching Hospitals

Private

Please provide the following information for your company
Enter "N/A" if not applicable.

Commercial Registration

MOH Registration

Import License

What requirements would there be for SpineCraft to register our products in your market?

How did you hear about SpineCraft?

Google or other search engine

Twitter

Tradeshow/Exhibit

Contacted by SpineCraft

Surgeon or medical device distributor

Other

Phone

This field is for validation purposes and should be left unchanged.

Distributor Opportunities

Mission