Wholesale manufacturers of UVB phototherapy.

Dermaray reseller & distributor application

Please use this form to express your interest and apply for our exclusive and non-exclusive distribution programs.  On receipt of your applications, we will forward our export policy documentation should we accept your application.

 

First name:

 

Last name:

 

Company:

 

Web page:

 

Email:

 

phone (H):

 

phone (W):

 

Cell phone:

 

Fax:

 

Address #1:

 

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Address #3:

 

Address #4:

 

City:

 

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Please provide detailed history of your organisation, including company structure, size of the business, technical capabilities, number of staff, years trading, how you conduct your business and primary markets.

 

 

 

Presently, what are your main product lines, brands sold, services offered, quantity of related business. What products are you primarily interested in from us?

 

 

 

Please let us know what program you are interested in, exclusive distribution in your area, a standard reseller program or a drop ship program from our stock?

 

 

 

Thank you for your time, we appreciate that it is valuable.

(please press submit only once and wait for the confirmation page.)

 

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