Service Quote Request Form

Quote Request Form

Importer of Record Service Request - MDEL
Name *
Company *
Address
City
Country
Email *
Telephone
Preferred contact method *
Email
Telephone
Device Classification & Type *
Class I
Class II
Class III
Class IV
Sterile device
Temperature Controlled Storage Required
Other device information that may be essential
Total number of products to be imported *
Therapeutic area *
Dermatology
Dental and Oral Health
Family Medicine
Nutrition and Weight Loss
Obstetrics/Gynecology (Women’s Health)
Rheumatology
Trauma (Emergency, Injury, Surgery)
Pulmonary/Respiratory Diseases
Psychiatry/Psychology
Podiatry
Sleep
Otolaryngology (Ear, Nose, Throat)
Ophthalmology
Musculoskeletal
Infections and Infectious Diseases
Immunology
Cardiology/Vascular Diseases
Endocrinology
Gastroenterology
Hematology
Hepatology (Liver, Pancreatic, Gall Bladder)
Neurology
Nephrology
Pediatrics/Neonatology
Urology
Orthopedics
Other therapeutic area
Brief Description of Product(s) *
How did you know about us?
Verification code.*