> Quote Form Request
Medical Product & Services Quote Form Request
To ensure the smooth and accurate transfer of information and increase the probability of a successful sale, we prefer to issue the offer and all subsequent paper work directly to the Principal (the Company that will sign the contract and issue the letter of credit to our bank).
To facilitate this process we have created the following format. The instructions are self-explanatory, however, we will be pleased to answer any questions, at any time. If the individual or corporation who has completed this form is not the Principal, then they shall be considered the lead intermediary.
If you are not the Principal, please request the following information from the Buyer. This is necessary for us to quote a contract price. Our prices are very competitive and we have available contracted supplies to satisfy most orders. All Quotes in USD.
 Please be advised that our business is only with private concerns. We do not accept government tenders.


Principals Name      
                         First                 Middle               Last Name

Contact Title

Home Address
City       Zip Code
State      Country
Home Tel. No.

Organization Name Proprietorship Firm Corporation
Cert. of Incorporation Number (In case of a corporation):
Address (Registered Office)
City       Zip Code
State      Country
Tel. No.
Type of Business
E-mail Required
E-mail Reconfirm
Your Companies URL
Year Organization Started

Type of the Account :
Company Account Personal Account

Name of the Bank

Name of the Bank Officer

Bank Telephone / Fax

Bank Address

Bank City & Country

Bank E-mail

Trade Reference 1

Trade Reference 2

Product: Please Choose One
Specs / Other ( Specify )

Total Quantity

No. of 20' / 40' / 45' Containers Per Month

Accepts Payment Terms Clause

Import License Number

Import License Expiration Date

Authority Issuing Import License

Palletized Slung Bulk BreakBulk

USD Target Price Per Unit Required To Receive Quote:

Shipment required at : Port / Airport Name Country

Price Basis :     Specify :

Comments / Details