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Latin America / Services / Supplier Registration

Becoming a Teleflex Latin America Distributor

The following steps should be taken if you are interested in becoming a distributor:

Review our product portfolio and determine the segment of interest. Please ensure alighnment between with your focus/call points and what is being requested.
Fill out the following documents and attach them to this request prior to submitting it:
- a) Credit Application Form
- b) Trade Compliance Questionnaire
Provide the profile information requested below.

A Teleflex representative will review your information and will contact you.

Please note: Required fields are indicated by "*" icon. You must read and accept our Terms and Conditions of Use, and Privacy Policy in order to submit this form. Teleflex does not respond to form letters or e-mail campaigns.

Which Teleflex Brand Products do you currently distribute?

Anesthesia

Cardiac

Urology

Interventional

LMA

Respiratory

Surgical

EZ-IO

OnControl

A. Your Company Information

Company Name * Required

Address

City

State

Country

ZIP/Postal Code

Phone Number

Fax Number

TFX Account #

B. Key Contacts in your Company

Owner #1

Name

Phone

Cell Phone

Owner #2

Name

Phone

Cell Phone

Controller

Name

Phone

Cell Phone

Procurement Manager

Name

Phone

Cell Phone

Regulatory Manager

Name

Phone

Cell Phone

Sales Manager

Name

Phone

Cell Phone

Marketing Manager

Name

Phone

Cell Phone

C. Product Lines

Of the companies you represent today, please indicate your top three:

Company 1

Company

Specialty

Percent of Total Sales

Number of years you represent this line

Do you hold inventory? (Yes/No)

Company 2

Company

Specialty

Percent of Total Sales

Number of years you represent this line

Do you hold inventory? (Yes/No)

Company 3

Company

Specialty

Percent of Total Sales

Number of years you represent this line

Do you hold inventory? (Yes/No)

D. Your Sales Organization

How many full time sales representatives?

Indicate the geography(ies) you sell into

Do you have clinicians?

Who in your office is responsible for product training?

Do you have branch offices? Where?

Which local trade shows will you attend this year in your country?

When and where?

Percent of Business (Public)

Percent of Business (Private)

Percent of Business tender

Percent of Business nontender

Who is responsible for the forecast of Teleflex line of products?

Do you have your own literature? If yes, could you send us a set?

Trade Compliance Form: * Required

Credit Application: * Required

Acknowledge Terms and Conditions: *