Are you acting in an individual capacity or representing a company/organisation?
YesNo

Company Legal Name (if applicable)

Full name of Contact Person

Email Address

Phone Number

Address Line 1

Address Line 2

City

Zip or Postal Code

Country

Company/Organisation Type
ManufacturerSupplierPersonal

Which types of equipment can you offer/donate? Please tick all that apply.

What quantities and prices can you offer the different types of equipment at?

What are the minimum order sizes? (if applicable)

What are the lead times? (if applicable)

Can you provide evidence that your products are/were manufactured in a regulated facility?
YesNo

Do you have an export licence?
YesNo

Can you provide the physical address or your manufacturing/supply facility and confirm if you are happy for it to be physically inspected by agents of the buyer?
YesNo

Incoterms for Place of Delivery

What are your payment terms?

Prior Equipment Selling/Manufacturing/Donation details (if applicable)

How did you hear about us?

Referral Name (if applicable)

Any other comments or information?

Send