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Distributor Questionnaire

COMPANY INFORMATION

Company Name *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Primary Point of Contact: *

Primary Phone Number: *

For Texting & WhatsApp

Email *

Website / URL

Regulatory Documents *

ISO 13485
MDR/CE
FSC
Technical File
Declaration of Conformity
Risk Control

PRODUCTS

Which product(s) are you interested in?

KERATACx™ Intracorneal Rings
DIFFRACx™ Trifocal Lens
Capsular Tension Rings
Monofocal IOL
Hydrophilic IOL
Hydrophobic IOL
PMMA IOL
KERATACx™ Vacuum System
Viscoelastic (HPMC, HA)

Are you wanting to market with IMT brand or your own brand?

IMT
Your Own

MARKET

How long have you been in the Ophthalmic Industry?

Which country/countries are you interested in registering?

Which of the following do you serve?

Hospitals
Clinics
Doctors

If You Have Any Questions

Contact us at info@imt-usa.com

Made in the USA

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Contact Info

IMT headquarters is located in Georgia, USA
info@imt-usa.com
+1 (678) 605-9749

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