Pharmaceutical Product -Marketing Inquiry

First name (*) :

Last name (*) :

Title (*) :

Company you represent (*) :

Website of the company (*) :

Your Email (*) :

Your phone number (*) :

Please summarize the main reason of requesting to promote your company / product with us:

Please select what best characterizes the main purpose of your interest to visit us
Product- I wish to promote our product with hope you would be interested in prescribing it to your clients/patientsProduct- I wish to promote our product with hope you would be interested in recommending it to other colleaguesCompany- I wish to promote our company with hope you would be interested to engage in business with usI have other reasons

Please list your professional background and years of experience in your field (*) :

Please list Please list up to 3 most important facts why you think you product is better than other similar products currently on the market :

1.

2.

3.

Please list an approximate price or cost of your product a customer (patient) would have to pay should he/she needed to pay cash out of pocket for your product at a full price per month – in USD(*) :

Upload the product or company information (Max size 5MB) :

I am submitting this inquiry with the understanding that I accept full responsibility for being truthful about all information provided as well as the understanding that this form is no guarantee of an invitation for a business meeting or other business related activity.
Should we reach a decision to contact you our general response time is 3-5 business days.

Please sign your request (*) :

(*) Required fields