Summit Medical | Shippert Medical Technologies

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Distributor/Representative Inquiries

Summit Medical CE marked products are sold worldwide through a network of independent representatives and stocking distributors.  We invite inquiries from interested potential reps and distributors.  Please complete the following form to give us an overview of your business. 

Contact Name:
Title:
Company:
Address:
Phone Number:
Fax Number:
E-mail:
Year Founded:

Website:

Corporation    Partnership    Sole Proprietorship    Other:

Dunn & Bradstreet
What territories do you cover?

What Summit Medical product lines are you interested in representing?
Ear, Nose & Throat
InstruSafe Product
Minne Ties

Which manufacturers do you currently have representation agreements?
Do you consider any of your current products to be competitive with ours? Which ones?
Whom do you consider to be your largest competitors?
Areas of Specialty:
Provide a Brief Description of your Business:
 


Accounting Contact:
 
Phone:
E-mail:
 
Accounts Payable Contact:
 
Phone:
E-mail:


Credit References (Other Manufacturers):
Reference #1
Company Name:    
Company Address:
City: State: Postal Code: Country:
Phone: Fax:
Reference #2
Company Name:    
Company Address:
City: State: Postal Code: Country:
Phone: Fax:
Reference #3
Company Name:    
Company Address:
City: State: Postal Code: Country:
Phone: Fax:

Bank Reference:
Account #:   
Name of Bank:    
Address:
City: State: Postal Code: Country:
Phone: Fax:
 

Comments/Questions:

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