Private Equipment Partner

Intake Form - Private Equipment Partner

    Company Information:

    Product Information:

    List of products/equipment offered:

    Product Certification and Approval:

    Please list them :

    Market and Usage Information:

    Partnership and Collaboration:

    Sales and Distribution:

    What is your preferred sales model with MD Global Care?

    Marketing Collaboration:

    Support and Training:

    Referral Information:

    Additional Information:

    Consent Agreement: