Distributor Opportunities

Please complete and return this form if you are interested in becoming an Excellagen distributor.

Olaregen Therapeutix Inc.
1001 Avenue of the Americans, 2nd Floor
New York, New York 10018
Phone: 1-844 - WOUNDS4
Email: info@olaregen.com

I would like to introduce my company and to let you know that we are interested in distributing your product through our company. Our company info is:

Name *
Phone *
We have been in business for __ years.
Our annual sales volume is estimated at:
Please provide the following information: 1) Number and location of distributors? 2) Segments of specialty ie. VA, Institutional, Wound Care Centers, etc.? 3) Minimum monthly quantities expected to sell? 4) Total number of sales representatives? 5) Key contact name, email and phone number?