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International Distributor Questionaire

Please provide the below information if your firm is interested in representing Vascular Solutions’ products in your area.

General Information

Name (Required):

Primary Contact:

Address:

City:

Country:

Postal Code:

Phone Number (including country and city codes):

Fax:

Email:

Buyer:

Marketing Information

Number of cardiac catherization labs in your country:

Number of labs performing interventional radiology procedures:

Number of coronary angioplasties/stents/atherectomies per year:

Number of coronary angiograms per year:

Number of peripheral angioplasties per year:

Number of peripheral angiograms per year:

Percentage of peripheral work performed by cardiologists:

Name the top 3 hemostasis sheaths used in your country:

What are the most widely used sheath sizes?

Angiography:

PTCA:

Stents:

IABP:

Are vascular sealing devices currently being sold in your country?

Yes No

If yes, which ones? (Please list price and market share.)

Angio Seal:

Perclose:

Vasoseal:

Syvek:

Clo-Sur P.A.D.:

Chito-Seal:

Other:

In your market, what would the advantages be for physicians to use a topical hemstatic patch?

Are soft thrombus aspiration catheters being sold in your country?

Yes No

If yes, which ones? (Please list price and market share.)

Possis:

Endicor-X-sizer:

Diver CE:

Other:

In your market, what would the advantages be for physicians to use a soft thrombus aspiration catheter?

Are endovenous laser systems to treat varicose veins being sold in your country?

Yes No

If yes, which ones? (Please list price and market share.)

Diomed:

Bio Litic:

Dornier:

Other:

In your market, what would the advantages be for physicians to use an endovenous laser system to treat varicose veins?

Please list below the top three physicians that your organization has access to for clinical evaluations/new products:

Physician's Name:

Hospital:

Physician's Name:

Hospital:

Physician's Name:

Hospital:

Market Support Information

Please list the top three trade shows or symposia your physicians attend:

What sales support literature does your organization prefer? (Rank in order of importance: 1 is most important, 8 is least important.)

Brochure:

Flip Charts:

Videos:

CD-ROM's:

Working Models:

Power Point Presentations:

Clinical Papers:

Give-away Items (Shirts, Pens, Bags, etc.):

Please type the text above into the box below.

Vascular Solutions

Bringing Solutions to Vascular Medicine

International Distributor Questionaire

General Information

Company Information

Marketing Information

Market Support Information