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Partner Application Form

Partner Application Form

Kindly fill-in and submit below Partner Application Form if you are interested in distribution of 3DISC products in your region. Upon receipt we will contact you to discuss a possible partnership.
Data will be kept confidential.

Contact information
Company Name*
Street address*
City*
Zip code*
Country*
State*
Phone*
Cell Phone
Fax
Website*
Contact person first name*
Contact person last name*
Contact person title*
Email*
Organization
Total employees*
Total sales staff*
Total technical staff*
What was your turnover last financial year (in USD)?*
In which year was the company established?*
Your customers
Which customers do you sell to and how?*
- Dental Clinics
- Dental Labs
- Hospitals
Do you sell directly to your customers or via dealers*
- Directly to customers
- Via dealers
Products
Do you sell Intraoral scanners?*
- Yes
- No
Which brand(s)?*
Please estimate the total annual IOS market volume in your country (in units)*
Which national/regional shows relevant to 3DISC products do you participate in?*
In which media would you promote 3DISC products?*
Please upload your company profile or other relevant information you would like to share with us
Drop files here or
*
- Yes, I agree to the 3DISC privacy policy 1.1 and to 3DISC processing my contact data with the purpose of responding to my given request to become a 3DISC business partner.
- Yes, sign me up for the quarterly 3DISC Dental Newsletter.
Phone
This field is for validation purposes and should be left unchanged.

Partner Application Form

Contact information

Organization

Your customers

Products