Contact Person *

First Name

Last Name

To whom are you selling to? (✔ where applicable) *

Direct to end user

Distributor / Dealer

Both end user and distributor

Other

How many sales representatives does the company have? (✔ where applicable) *

≤ 3 people

4 - 10 people

> 10 people

How focused is the company in the dental industry? (✔ where applicable) *

≥ 80%

50% - 79%

≤ 50%

What is the percentage revenue on disposable items e.g. glove, face mask, dam, plastic and non-woven? (✔ where applicable) *

≥ 80%

50% - 79%

< 50%

Are you currently selling gloves? (✔ where applicable) *

Yes

No

if yes, what is the estimated annual purchase for glove? (box of 100 pieces) (✔ where applicable)

< 15,000

15,000 - 30,000

30,000 - 50,000

>50,000

Is your company engaged in CSR Program? (✔ where applicable) *

Yes

No

If yes, what is the focused area? (✔ where applicable)

Dental / Medical care

Global warming

Endangered species

Other