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This information will enable us to gain some insight into your company, and help us to improve our service to you in the future. Thank you for you assistance.

Name:
Title:
Company Name:
Company Address:
 
 
 
Year Established:
Phone:
Fax:
Email:

I. TYPE OF BUSINESS
Agent Exporter Importer Retailer
Distributor Hospital Manufacturer Wholesaler

II. YOUR PRODUCT INTEREST
Wheelchairs ADL General Medical
Rehabilitation Orthopedic Disposable
Bathroom Electromedical Respiratory
Other

III. SALES VOLUME : YOUR COMPANY'S APPROXIMATE YEARLY SALES VOLUME IN US$
Between $100,000 to $500,000
Between $500,000 to 1 Million
Between 1 Million to 5 Million
Between 5 Million to 10 Million
Between 10 Million to 15 Million
Over 15 Million

IV. NUMBER OF EMPLOYEES:

V. DOES YOUR COMPANY CURRENTLY IMPORT FROM TAIWAN?
YES
NO

VI. DOES YOUR COMPANY CURRENTLY IMPORT FROM CHINA?
YES
NO

VII. HOW DID YOU HEAR ABOUT OUR COMPANY ?
Taiwan health magazine
Formosa magazine
Medical Equipment & Supply Guide
Internet
Other
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