DISTRIBUTION COMPANY INFORMATION Your name (required) 1. Identity Company Name (required) Address (required) Postal Code (required) City (required) Country (required) Telephone (required) Your Email (required) Year company established (required) Number of employees (required) Assets Company type 2. Key Personnel Name Title Managing Director Sales Manager 3. What geographical territory(ies) do you sell in? (required) 4. Do you have offices or affiliates outside of your own country? YesNo If yes, please provide company names, city and country 5. Do you sell direct to end users? YesNo To other Distributors? YesNo 6. Which end-user markets do you address? (required) DermatologistsHospitalsHospital PharmaciesIndependent pharmaciesWholesalersHealth insurancesDrugstoresGeneral Physicians 7. Approximate annual turnover (required) Your Message [recaptcha size:compact]
