New Retail Business Inquiries – MediChic

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Become a medichic retailer

Thank you for you interset in becoming a medichic retailer.

Please complete and submit the form below and an account executive will follow up with you in 3-5 business days.

Information About You

Name

Email

Job Title

Information About Your Business

Business Name

Country

Street

City

State

Zip

Business Phone

Business Emall

Cell Phone

Website Url

Do you sell products onine? If yes please list where you sel

Type of business

Uniform Store

Medical Supply

Screenprinter/Embroidary

Gift Shop

Mobile/On-site

Promotion Products

Ecommerce

Other

How long has your company been in business?

How many location do you have

Where do you intend to sell Medichic products?

Retail Store location(s)

Website/Online Store

Group Sales

Hospital Shows

Online Marketplace

Others

Do you Stock merchandise?

Yes

No

How did you hear about us?

Social Media

Work Referreal

Person Referral

Retail Store

Others

What brands authorized to sell? Any other information you would like to submit in consideration of your application?

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