Dealership Application

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Please provide your full name, email, and company in the required fields. Once registered online, you will receive a follow-up email further detailing the application process.

Name of Applicant *

Email address *

Name of organisation *

Office address *

Telephone Number *

Website *

Area of interest *

Products Sold (including brand, and whether manufacturer or authorized dealers) *

Locations/region at which Applicant proposes to sell Medtra Innovations products *

What products do you/your firm currently sell into hospitals? *

How long have you/your firm been selling medical equipment? *

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