International Distributor Questionaire

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

General Information
Name:
Primary Contact:
Address:
City:
Country:
Postal Code:
Phone Number:	(Including Country and City Codes)
Fax:
E.Mail:
Buyer:

Company Information

Territories Covered; number of field sales personnel and indicate if you have a clinical specialist:

List of cardiology/radiology devices and the specific manufacturers you are presently representing:

Describe the regulatory/registration process in your country for topical hemostasis patches, soft thrombus aspiration catheters and endovenous laser systems to treat varicose veins:

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: Export Catheter: 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: Physicians Name: Hospital: Physicians Name: Hospital: Physicians 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 Working Models Power Point Presentations Clinical Papers Give Away Items (Shirts, Pens, Bags, etc.)

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