Partners Questionaire

Company Information

Company Name (mandatory field)

Company Name extension

Building (if applicable)

Street (mandatory field)

P.O. Box (if applicable)

ZIP code (mandatory field)
City

Country (mandatory field)

E-Mail (mandatory field)
Phone
Fax

VAT ID (valid for European partners only)

Delivery address

Product Receivers Address

Extended information

Year of foundation (mandatory field)

Owners name (mandatory field)
Owners e-mail

Business Manager CEO (mandatory field)
Business Managers e-mail

Bank details

Name of the Bank (mandatory field)

IBAN code (mandatory field)

SWIFT / BIC code (mandatory field)

Classification

You would classify yourself as
DistributorManufacturerEnduser

Market information

Target Client Group share (%)

Private practise
Hospital labs
Private labs
University
Government

Economical Strength

International currency (mandatory field)
US-DollarEUR

Yearly turnover

Product share (%) (mandatory fields)

Instruments
Consumables
Service

Competitors in your market

Competitor 1 (Name)
Market share (%)

Competitor 2 (Name)
Market share (%)

Competitor 3 (Name)
Market share (%)

Company presentation

Company Website

Additional personal message

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