Distributor request form
Please fill out this application form if you are interested in becoming a distributor of Semmelweis Scanner in your region.
Key contact name *
Key contact email *
Company name *
Address *
Legal form *
Established in *
MM
/
DD
/
YYYY
Owners' name and share *
Turnover in the last 3 years *
specify in million EUR
EBIT in the last 3 years *
specify in million EUR
Composition of turnover by product group (market) *
Company headcount in the last 3 years *
Number of salesforce in the field *
Which market segments are you interested in? (e.g. healthcare, food, biotech) *
specify any relevant current partnerships
Countries to cover with distribution *
specify any relevant current partnerships
Other remarks
*
Required
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This form was created inside of Hand-in-Scan.