Partnership application

Commercial Partner Application

Importers, distributors, brokers and agencies: tell us about your market so we can explore a commercial partnership.

Licenses & certifications

Licenses and certificates you hold

Select every item that applies. We will ask for copies during onboarding.

License numbers, issuing authorities and expiry dates

Compliance or inspection notes

Primary contact

Full name *

Job title

Email *

Phone

Preferred language

Anything else we should know?

Confirmations

We confirm the certification and license information in this application is accurate, and that we can provide copies of every certificate we hold. *We understand and accept that, once a mutual NDA (Non-Disclosure Agreement) is signed by both parties, we must provide Medelicia with copies of all certifications we hold before entering into any commercial business relationship. *We confirm that the information provided in this application is complete and accurate. *

Submitting this form does not create a business relationship. Any partnership is subject to a signed agreement between both parties.

Commercial Partner Application

Company information

Market & portfolio

Licenses & certifications

Primary contact

Confirmations