Business Partner Request Form

Company Name (required)

Main Contact (required)

Your Email (required)

Street Address (required)

City (required)

Office Phone

Mobile Phone

Company Website URL

Company Profile (please check all that apply)
Manufacturer Dealer Distributor Reseller Other 

Do You Presently Service and Support Your Products?
 Yes No

Are You Interested in Expanding?
 Yes No

What are the main products you support?
Practice Management Digital Imaging Digital Sensors X-Ray Generators Panoramic Units Cephalometric Units Scanners 3D CBCT Units Intra-Oral Cameras Computers Networks 

How did you hear about NTG?

How do you think NTG might be able to help you reach your goals?