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If you wish to become a MIR agent/dealer
please provide your informations
(*Required)
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Company name
*
Contact person
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Country
-- Select Country --
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Congo, The Republic Of
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-- Select a State --
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Email
Do you have a website?
How many sales people do you have?
Select
1-5
6-10
11-50
more than 50
How many technicians do you have?
Select
1-5
6-10
11-50
more than 50
Are your sales nation wide or regionaly based?
nation wide
regionally based
What market area?
Select
Public/Hospitals
Occup.Medicine
Peaditricians
Pulmonogists
Sport Med.
Clinical Trials
Telemedicine
Other
Does your company distribute spirometers?
yes
no
Does your company distribute oximeters?
yes
no
Does your company sell to public Hospital/Clinic?
yes
no
What is the sales ratio between public and private?
more public
more private
Is there any reinbursement for Spiromety?
yes
no
Is there any reinbursement for Oximetry?
yes
no
Is the 6MWT required in country for O2 prescription?
yes
no
Is any registration required to import medical devices in your country?
yes
no
Are you interested in the disposable turbine?
yes
no
Please select what products you are interested in
Products
Q.ty
spirodoc
spirolab III (color version)
spirolab III (color version) with SpO2
spirolab III (B/W version)
spirobank II
spirobank II with SpO2
MIROxi
MiniSpir
MiniSpir with SpO2
spirobank G (new USB version)
spirobank USB
Oxi-Pulse
spirotel
spirotel with SpO2
FlowMir - Disposable turbine (1 box/100 pcs)
Telemedicine
Please write below any other request
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MIR Medical International Research Inc.
1900 Pewaukee Road
Suite O, Waukesha, WI 53188 USA
Tel:(262)565-6797 Fax:(262)364-2030
MIR Medical International Research S.r.l.
via del Maggiolino, 125
00155 Roma, ITALY
Tel:(+39)0622754777 Fax:(+39)0622754785
©1996-2012 MIR P.Iva IT04564101006
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