Become a Kollsut Distributor

Are you interested in distributing or carrying our line of products? Please complete the form below. All fields must be completed. After submitting your form, you will be able to purchase your Distributor Package which includes:

• Welcome Letter
• Catalog
• Distributor Price List
• Suture Samples
• Kollsut Forms:
  • Sutures Order Form
  • Samples Sutures Order Form

Price including shipping and handling is $149.95 anywhere.

Company:
Contact Person:
Title:
Email:
Address:
City:
State:
Zip:
Country:
Phone:
Fax:
Current line of products:
Number of employees:
Years Incorporated:
Which states do you do business in?:
Is your company publicly or privately owned?:	Select Public Private Ticker symbol?
Estimated Annual Sales:
Comments or Questions: