This questionnaire serves medion GmbH, Essen as a basis for an assessment, whether an enterprise is qualified to merchandise products of medion GmbH in the secondary area (--Overstock production, 2nd choice products, none used guarantee returns -- defect goods).

Information about the enterprise

Name of enterprise:
Managing director:
Contact:
Street, no.:
Zip code, place:
VAT ID:
Telephone:
Fax number:
Mobile number:
E-mail address:
Homepage:
Place of the enterprise:
Place of jurisdiction:
Year of the foundation of the enterprise:
Current number of employee:
Average employee number of previous year:
Expected sales volume current year:
Sales volume previous year:
Business activity of the enterprise:

Please enclose the following enclosures:
- trade registration
- Balance sheets/annual accounts of the last two years

Enclose only a ZIP- or TAR-file (max. 10 MB):

Preferential product groups

Please mark the product groups which you would like to sell with a cross.