Mediplus

Application to be a Mediplus International Distributor

Does your company wish to become an international distributor? Completion of this form is the first step in the process. We look forward to hearing from you.

Please note, fields marked with * are mandatory.

Name *
Position *
Company *
Address
Phone *
Fax
Email *

Products you wish to distribute

Urology
Urodynamics
GI
Anaesthetics
Theatre and Other

Brief description of your company.

This must include, date of formation, annual revenues, products covered, Principals represented, number of sales staff.