VSD regional agency application form

Filled by:Date:
Company name:Nature of business:Tel:
Address:Zip code:
Name of principal:Tel:Mobile No.:
Business license (number):Business permit(number):
Credit status:
  • Registered capital
  • Working capital
  • Trade receivable
  • Trade payable
Regional agency:
Province City
Hospital agency President Equipment chief Application department Department director
First year plan sales for joining "VSD" :piececapital that planned to invest by "VSD"yuan
Your company's operating period:yearPrincipal's duration in equipment industry:
Your company's current business scope:
he main varieties of your company:
Whether distributed the famous products or not (equipment, pharmaceutical):
Annual sales (amount) of the above varieties:
Whether distributed famous orthopedics products (equipment, pharmaceutical):
Annual sales (amount) of the above varieties:
Local competing products:
What channels do you know about "VSD"?
Have you ever asked a doctor with a "VSD"?
What is the expert? (hospital, department, name)
Number of existing sales force:Planned number of VSD sales:
Would you like to receive the VSD unified sales management of our company:YesNo
Whether to recognize the seriousness of the contract:YesNo
Do you understand the "VSD" market status? Specifically?
Recommendation (policy, training, etc.) for VSD sales:
Regional market development plan (focus on resources, etc.).
*Please fill out each item carefully