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HOME PAGE EQUIPMENT PRICE LISTS DEALERS ABOUT US CONTACT US

Afrok Medical Equipment is dedicated to researching on behalf of your company. For brand name products and comparable products at competitive prices. 100% prepayment is required for international orders via wire transfer or irrevocable letter of credit.

If you wish to become a distributor, please complete this distributor form.

Dealer application form
Company name:
Address:
City:
State:
Country:
Telephone no:
Fax no:
Your name:
Your title:
Email address:
Website address:
Date organized(company):
Annual Sales(U.S. Dollars):
Business licence no. and Country currently registered in:
Contact person:
Contact email:
You are: Distributors
Laboratories
Government
Doctors
Other:
Geographical area served:
Anticipated annual purchases from Afrok Medical products:
Number of outside salesmen:
Number of inside telemarketers:
How did you hear about us:
Comments:
Security code: 78187
 
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