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EXPORT FORM FOR POTENTIAL DISTRIBUTORS
To accompany Company Presentation
(emailed separately to
Export@francemedpharma.com
)
*
Indicates required field
Name
*
First
Last
Position
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Company Name
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Email
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Tel. No.
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Town, Country
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website
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Size of Business & T/O
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Enter number of staff & T/O
Number of Sales Reps.
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Number of Medical Reps.
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Years in Business
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Number of outlets supplied
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Distribution Network and Type of outlets supplied: Pharmacies, Supermarkets, Hospitals, Doctors.... Other
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Enter number of each type of outlet
Products/brands you currently distribute exclusively. State whether the products are ethical drugs, OTC, personal care or other.
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Enter experience in importing, registering OTC products, Class IIa Medical Devices and Distribution in your country.
The Doctors visited by your Medical Reps.
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Enter the therapeutic fields the doctors visited by your reps, practice in. Whether the doctors are General Practitioners, Hospital Consultants or private doctors or specialists.
Which Therapeutic Fields e.g. Dermatology, Paediatrics, Gynaecology..etc are you interested in or work mainly in?
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List in order of importance
Which FranceMed Pharma brands/Products listed in this website are of interest to you?
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List in order of importance
Submit