Export - FranceMed Pharma

EXPORT FORM FOR POTENTIAL DISTRIBUTORS
To accompany Company Presentation
(emailed separately to Export@francemedpharma.com)

* Indicates required field

Name *

First

Last

Position *

Company Name *

Email *

Tel. No. *

Town, Country *

website *

Size of Business & T/O *

Number of Sales Reps. *

Number of Medical Reps. *

Years in Business *

Number of outlets supplied *

Distribution Network and Type of outlets supplied: Pharmacies, Supermarkets, Hospitals, Doctors.... Other *

Products/brands you currently distribute exclusively. State whether the products are ethical drugs, OTC, personal care or other. *

The Doctors visited by your Medical Reps. *

Which Therapeutic Fields e.g. Dermatology, Paediatrics, Gynaecology..etc are you interested in or work mainly in? *

Which FranceMed Pharma brands/Products listed in this website are of interest to you? *

Submit

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