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Director(s) / Owner(s) Names:
Phone: Fax: Mobile/Cell:
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Total Employees: Number of Employees in Sales:
Number of Employees in Servicing:
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Target customers (check all that apply): Public / Government hospitals Private hospitals Nursing homes General Practitioners Other distributors Diagnostic centres / Laboratories Turnkey projects Other
Area(s) of speciality (check all that apply): Anaesthesia Biotechnology Cardiovascular / Cardiology Clinical Chemistry Dentistry Ear, Nose and Throat Gastroenterology / Urology General Surgery Plastic Surgery Haematology Immunology IVD Microbiology Neurology Neuro-surgery Obs/Gyn Ophthalmology Orthopaedics Pathology Radiology Other (please provide details in comments below)
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