MODULAR OPTICAL SPECTROSCOPY INSTRUMENTS

New Prospective Representative Questionnaire

If you are interested in becoming a representative for Sciencetech, please fill out the following questionnaire.
Your information will be sent to our 'VP of Marketing' for consideration.

Note: The following information will be kept confidential and will not be distributed or sold to any 3rd party
organization.

 

Contact Information

Name

Position/Title
Company Name
Street address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX

E-mail

Company Information

Number of Full Time Employees

Other regional office or service center 

What other Companies/Products do you represent?

Describe your marketing activities?

Which other company do you currently distribute on an exclusive basis?

Which market sector do you operate and specify the approximate market share? 

Biomedical % of market shares
Chemical % of market shares
Other % of market shares

If Other, what other market sectors do you represent?

Note: Above should add up to 100 %

Academic % of market shares
Corporate or Government % of market shares

Note: Above should add up to 100 % 

Comments:

   

 

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