Reseller-Questionnaire In case your browser does not support forms please send info by e-mail to medical@fineimage.com or fax it to +66-2-3738123
I am
Nurse
Doctor
Physician
Therapist
Dealer
Manager
Director
Company
Clinic
Hospital
Institution
Beauty Farm
Retail Shop
Mail Order
Wholesaler
Value Of
First Order
US$ 1,000.00+
US$ 2,000.00+
US$ 3,000.00+
US$ 5,000.00+
Expected
Annual Purchase
not known
US$ 5,000.00+
US$ 10,000.00+
US$ 25,000.00+
Messages/Questions
Please mark all product groups that are of particular interest to you!
Please list any missing product groups you would like to see in the field for Messages/Questions
Enema/Douche Products
Rubber Rings
Bed Pans
Ice bags
Rubber Sheets
Proctoscopes
Stethoscopes
Latex Gloves
Breast Pumps
Thermometers
Trays/Containers
Otoscopes
Syringes
Speculums
Sphymomanometers
Catheters
Rectal Tubes
Examination Chairs
Please fill in completely and submit if you wish to establish a reseller account!