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Distributor Application

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Phone: 978-632-2555
Toll Free: 800-253-3684
Toll free not available outside the US.
sales@biomedicalpolymers.com

If your company would like to become a distributor for Biomedical Polymers please provide the following information. Someone will be in contact with you shortly.

Thank you for your interest in Biomedical Polymers.

Legal Company Name
Bill To Address
Ship To Address
Phone Number
Fax Number
E-mail Address
Website
Principle Contacts
Owner/President
Finance
Sales Manager
Marketing Manager
Purchasing
Customer Service
Accounts Payable
Sales Information
How Long in Business
Annual Sales Volume
Number of Employees
Number of Sales Reps
Geographical Territory Covered
Focus Accounts: (Research, Clinical, Physician Labs etc.)
VAT # (VAT # required for all EU Countries)
Marketing Information
Does the company have a product catalog? (If yes, please make arrangements to provide a copy)
Current Marketing Programs
(Please Explain)
Commercial References
# Manufacturer Contact Name Address Phone # Fax #
1
2
3
4
Bank References and Account Numbers
Institution Name
Address
Phone #
Fax #
Account Number
Contact Name
Institution Name
Address
Phone #
Fax #
Account Number
Contact Name
Biomedical Polymers, Inc. payment terms are 30 days net, FOB Gardner, MA. Please provide any additional information or attachments that will help us to better understand your company and business model.
Name of the individual that filled out the application:
Date: