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Distributor Profile Form

 

Please fill in the form below. We will review the information you have sent in, and contact you about the possible steps to take next.
To read what this form is all about, click here.

 

 

Company Name:
 
Address:
 
Website:
 
Company Phone:
 
Company Fax:
 
       
Contact Person Position Email adress Mobile phone
       
Current / Past productlines Since Until Sales last FY in euros (optional)
Total sales:
       
Amount of sales people specialised in:
(please define target groups as listed below) *
1998 1999 2000 2001 2002

* if sales people are not specialised by target groups, please specify the amount of sales time spend by target group

       
Target Groups for the Distributor and Time Spent per Target Group in %:

abdominal surgery

(%)  

vascular surgery

(%)

interventional radiology

(%)  

gynaecology

(%)

lung surgery

(%)  

urology

(%)

cardiology

(%)   heart surgery (%)
orthopaedic surgery/traumatology (%)   neurosurgery (%)
plastic surgery (%)   other, please specify :  
         
       
Supplier Evaluation:    
       
Responsiveness:      

This parameter describes to which extent the Distributor responds to e-mails, voicemails, faxes or any other type of communication from the Supplier’s side.

Poor -1
2
3
4
5-Outstanding
       
Market Intelligence:    

This parameter describes to which extent the Distributor is willing and able to collect and share market data with the Supplier.

Poor -1
2
3
4
5-Outstanding
       
Sales & Marketing Plan Performance:    

This parameter describes to which extent the Distributor is involved in defining the S&M plan and it’s willingness to invest time, money and effort in the promotion of the Product.

Poor -1
2
3
4
5-Outstanding
       
Payment Behaviour:    

This parameter describes to which extent the Distributor fulfills its financial duties on time.

Poor -1
2
3
4
5-Outstanding
       
Effectiveness:      

This parameter describes to which extent the Distributor achieves the Sales & Marketing goals.

Poor -1
2
3
4
5-Outstanding