{"id":20481,"date":"2024-08-20T08:49:40","date_gmt":"2024-08-20T06:49:40","guid":{"rendered":"https:\/\/www.surgebright.com\/?page_id=20481"},"modified":"2024-08-20T10:06:45","modified_gmt":"2024-08-20T08:06:45","slug":"distributor-questionnaire","status":"publish","type":"page","link":"https:\/\/www.surgebright.com\/en\/distributor-questionnaire","title":{"rendered":"Distributor Questionnaire for 1099s"},"content":{"rendered":"<div class=\"wpb-content-wrapper\">[vc_row full_width=&#8221;stretch_row&#8221; bg_style=&#8221;fixed&#8221; css=&#8221;.vc_custom_1724140484392{padding-top: 200px !important;padding-bottom: 200px !important;background-image: url(https:\/\/www.surgebright.com\/wp-content\/uploads\/2023\/04\/Surgebright_Reinraum0190_HQ.png?id=16670) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}&#8221; wpex_bg_overlay=&#8221;dark&#8221;][vc_column]<style>.vcex-heading.vcex_6a7f99fba9654{color:#ffffff;font-size:40px;}<\/style><h1 class=\"vcex-heading vcex-heading-plain vcex-module wpex-heading wpex-text-2xl wpex-text-center vcex_6a7f99fba9654\"><span class=\"vcex-heading-inner wpex-inline-block\">Interest form for direct distributors<\/span><\/h1><style>.vcex-heading.vcex_6a7f99fba9fcc{color:#ffffff;font-size:25px;font-weight:300;}<\/style><h3 class=\"vcex-heading vcex-heading-plain vcex-module wpex-heading wpex-text-2xl wpex-text-center vcex_6a7f99fba9fcc\"><span class=\"vcex-heading-inner wpex-inline-block\">Complete this form to schedule an online meet &amp; greet<\/span><\/h3>[\/vc_column][\/vc_row][vc_row][vc_column][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1724141106633{padding-top: 25px !important;padding-right: 25px !important;padding-bottom: 25px !important;padding-left: 25px !important;background-color: #2babe3 !important;border-radius: 10px !important;}&#8221;][vc_column]<div class=\"vcex-spacing wpex-w-100 wpex-clear\"><\/div>[vc_column_text color=&#8221;#ffffff&#8221; font_size=&#8221;20px&#8221; font_weight=&#8221;bold&#8221;]Dear valued potential distributor,[\/vc_column_text]<div class=\"vcex-spacing wpex-w-100 wpex-clear\" style=\"height:20px;\"><\/div><div class=\"vcex-module vcex-divider vcex-divider-solid vcex-divider-left wpex-mr-auto wpex-max-w-100 wpex-block wpex-h-0 wpex-border-b wpex-border-solid wpex-border-main\" style=\"width:330px;border-bottom-width:2px;border-color:#ffffff;\"><\/div><div class=\"vcex-spacing wpex-w-100 wpex-clear\" style=\"height:20px;\"><\/div>[vc_column_text color=&#8221;#ffffff&#8221;]Thank you in advance for your cooperation in completing the questionnaire. The information you provide will allow us to better understand your company \u2018s business and commercial status and ability, as well as the market you are operating in. It will also enable us to ensure a firm mutually beneficial commercial relationship. We will not give away information to third parties.<\/p>\n<p>Please note that this questionnaire is only for the purpose of evaluating the potential of a partnership. This questionnaire is neither a promise nor a commitment to enter into contractual obligations.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column]<div class=\"vcex-spacing wpex-w-100 wpex-clear\"><\/div><style> style=\"border-color:#2babe3;\"<\/style><div class=\"vcex-form-shortcode vcex-module wpex-form wpex-m-auto wpex-max-w-100 wpex-form-gray wpex-p-25 wpex-border-solid wpex-border-2 wpex-rounded-md\" style=\"border-color:#2babe3;\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f20484-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"20484\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/20481#wpcf7-f20484-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"20484\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f20484-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p><label> KEY FACTS <\/label>\n<\/p>\n<p><label> Name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Phone number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-phone-number\" \/><\/span> <\/label>\n<\/p>\n<p><label> Company Name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-company-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-company-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> When was your company established?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-company-established\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"your-company-established\" \/><\/span> <\/label>\n<\/p>\n<p><label> Which regions do you cover?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-regions\"><textarea cols=\"10\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-regions\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> PRODUCTS \/ MAIN LINES <\/label>\n<\/p>\n<p><label> What products do you represent?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-represent-products\"><textarea cols=\"10\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-represent-products\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> OR Experience which kind of surgeries do you attend on a regular basis?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-or-experience\"><textarea cols=\"10\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-or-experience\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> Please explain why you see an opportunity for your business with surgebright:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-business-surgebright\"><textarea cols=\"10\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-business-surgebright\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> How many active hospitals & surgery centers do you have?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-active-hospitals-surgery-centers\"><textarea cols=\"10\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-active-hospitals-surgery-centers\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> How many of these accounts hold potential for surgebright product range?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-potential-accounts\"><textarea cols=\"10\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-potential-accounts\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> How do you promote your company? \/ yourself<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-promote\"><textarea cols=\"10\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-promote\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> FUTURE ASPIRATIONS <\/label>\n<\/p>\n<p><label> Where do you see your business going?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-business-going\"><textarea cols=\"10\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-business-going\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>[\/vc_column][\/vc_row]\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row&#8221; bg_style=&#8221;fixed&#8221; css=&#8221;.vc_custom_1724140484392{padding-top: 200px !important;padding-bottom: 200px !important;background-image: url(https:\/\/www.surgebright.com\/wp-content\/uploads\/2023\/04\/Surgebright_Reinraum0190_HQ.png?id=16670) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}&#8221; wpex_bg_overlay=&#8221;dark&#8221;][vc_column][\/vc_column][\/vc_row][vc_row][vc_column][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1724141106633{padding-top: 25px !important;padding-right: 25px !important;padding-bottom: 25px !important;padding-left: 25px !important;background-color: #2babe3 !important;border-radius: 10px !important;}&#8221;][vc_column][vc_column_text color=&#8221;#ffffff&#8221; font_size=&#8221;20px&#8221; font_weight=&#8221;bold&#8221;]Dear valued potential distributor,[\/vc_column_text][vc_column_text color=&#8221;#ffffff&#8221;]Thank you in advance for your cooperation in completing the questionnaire. The information you provide will allow us to&hellip;<\/p>\n","protected":false},"author":7,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-20481","page","type-page","status-publish","hentry","entry","no-media"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Distributor Questionnaire for 1099s - Shark Screw\u00ae<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.surgebright.com\/en\/distributor-questionnaire\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Distributor Questionnaire for 1099s - Shark Screw\u00ae\" \/>\n<meta property=\"og:description\" content=\"[vc_row full_width=&#8221;stretch_row&#8221; bg_style=&#8221;fixed&#8221; css=&#8221;.vc_custom_1724140484392{padding-top: 200px !important;padding-bottom: 200px !important;background-image: url(https:\/\/www.surgebright.com\/wp-content\/uploads\/2023\/04\/Surgebright_Reinraum0190_HQ.png?id=16670) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}&#8221; wpex_bg_overlay=&#8221;dark&#8221;][vc_column][\/vc_column][\/vc_row][vc_row][vc_column][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1724141106633{padding-top: 25px !important;padding-right: 25px !important;padding-bottom: 25px !important;padding-left: 25px !important;background-color: #2babe3 !important;border-radius: 10px !important;}&#8221;][vc_column][vc_column_text color=&#8221;#ffffff&#8221; font_size=&#8221;20px&#8221; font_weight=&#8221;bold&#8221;]Dear valued potential distributor,[\/vc_column_text][vc_column_text color=&#8221;#ffffff&#8221;]Thank you in advance for your cooperation in completing the questionnaire. 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