Distribution Enquiries
Your enquiry
How did you hear from us? *
I am contacting COSMED for *
Interested in the following COSMED Products *
Your answer
About you
First Name *
Your answer
Last Name *
Your answer
Position *
Your answer
Email *
Your answer
Phone
Your answer
About your company
Company *
Your answer
Year established *
Your answer
Website *
Your answer
City *
Your answer
Country *
Company structure *
None
1
2-3
3-4
>5
Number of employees
Number of sales representatives
Number of service engineers
List your 3 top product lines (brand and model)
Product 1 *
Your answer
Product 2 *
Your answer
Product 3 *
Your answer
List the three main events/congresses that you attend domestically
Event 1 *
Your answer
Event 2 *
Your answer
Event 3 *
Your answer
Your main markets
Specify your focus/presence in the following Markets *
Important
Slightly important
Less Important
Not Important
None
Hospital
University/Education
Sport Science & Performance
Primary Care
Health & Wellness
Geographical Market Coverage (check all apply) *
Do you have experience in selling Cardiopulmonary and Metabolic products *
If Yes, please specify Brand and Models
Your answer
Are you aware of the competition in your domestic market? *
If Yes, please specify Brand
Your answer
Form Confirmation
Next Step *
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Additional Comments
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