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If you are interested in becoming Hubang dealer, please fill in the following information*As required, we will contact you as soon as possible!

* Company name：
* Company address：
*Company Responsible：
*Mobile：
* E-mail：
*Telephone：
*Fax：
Registered capital：	万元（RMB）
Set up time：	(格式为:2008-08-08)
At present the company number of employees：
Engaged in the medical industry experience：
Please describe your company's advantage：
*Agent products：	New Products Featured Urban fashion series Manual wheelchair aluminum series Steel Manual Wheelchair Series Series of electric wheelchairs Toilet chair Walker / crutches Series
*Agent of province / City：
* If you have a valid business license:"",""" Corporation code certificate, tax registration certificate" ( including the tax certificates and tax certificate ),"" business license to operate medical equipment";
	Isnot
Other notes：