BMT Medizintechnik GmbH
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New Distributor Application Form
Please complete the following form. The fields marked with an asterisk (*) are mandatory.
• Name / Last Name *
• Company Name
, I am a stocking distributor.
• Email address *
• Telephone *
• Country *
• Website address
, it is an online store.
• How long have you been in business?
• How many sales representatives do you have?
• Do you currently sale other brands of surgical instruments? Which brands?
, I have previous experience selling surgical instruments.
• Please select the medical specialties you are interested in*
Oral and Maxillofacial Surgery
• Do you have any questions, comments or require further information?
• Confirm your consent
, I would like to receive via email special offers or promotions or other information from BMT.