Company profile

Company name
Street
Zip code/ City
Country
Phone/ Mobile/ Fax

Business owner
E-Mail
Purchasing Agent
E-Mail
VAT-ID Code
Delivery address &
phone number
E-Mail for invoices

Market Activities

What is your target market? ❑ Laboratories ❑ Dentists ❑ Dealers

Do you deliver to other countries?
❑ No ❑ Yes Which Country/s ______________________________________________

Your sales area: ❑ Nationwide ❑ Certain areas including _______________

Do you have sales representatives ❑ No ❑ Yes How many: __________

In which areas are you specialized in?

❑ Digital 3D printing ❑ Digital CAD/CAM ❑ Thermoforming materials ❑ Dental Acrylics

❑ Hygiene ❑ Operatory ❑ Dental packaging ❑ Preventive
❑ Disposable ❑ Infection Control ❑ Disinfection control (like hand sanitizer)
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Do you have a special showroom for lectures, courses and displaying products?
❑ Yes ❑ No
Please describe your marketing system:
(e.g. Nationwide distribution by sales representatives who visit dentists and laboratories, supported by telesales, and inside
staff. Visiting customers on a monthly, quarterly basis? Goods delivered by mail, courier, sales personnel?

How many dental laboratories / technicians do you have as clients? ______________________

Represented products and companies?

(Please name all, including manufacturers of competitive material)

Company: Exclusive ❑ No ❑ Yes

What trade shows do you attend? Do you have your own booth?

Our Products
Are you familiar with our product range?
Would you like a Keystone catalogue sent to you?

❑ No ❑ Yes

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Order Handling:
Desired form of delivery?

❑ UPS Air Freight ❑ United States Air Parcel Post (US Mail)
❑ Air/Ocean Shipment ________ ❑ Keystone Forwarder
❑ Prepaid Courier (Federal Express, DHL) using your account number
❑ Your preferred Forwarder/Carrier: ________________________________________

What specific certificates or documents do you/your government need for importation of our products?

General:

What voltage is used in your country?

❑ 220 voltage ❑ 115 voltage
❑ other: __________________ 2 or 3 prong plug: __________________

Suggestions, notes:

Thank you for taking the time to fill out this questionnaire so that we will be able to service your account
effectively in the future. Be assured that the information you have provided on this form will be treated
confidentially.

Please feel free to contact us with any questions or concerns that you may have.

Tel.: 0049 (0) 7731 912101 – Fax: 0049 (0) 7731 912102

Keystone Industries GmbH

Stockholzstr. 11
78224 Singen / Germany
sales@keystoneind.com

www.keystoneindustries.com

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