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Dealer Application

Thank you for taking the time to apply online for a dealership with Control-X Medical! We look forward to working with you soon...

Privacy Notice

We value your privacy and handle your information confidentially. It is used only by Control-X Medical for processing your dealer application and will not be shared with any third party. If for any reason the application is rejected, we delete all the information upon your request.

Fields marked with (*) are required for submission. For a successful on-line application, we suggest to fill out all applicable fields. We may contact you for further details and to provide you with more information on Control-X dealership.

1 of 3: Contact Information
Yor name: * Salutation First Last Suffix
Your title: *
Company / organization: *
Address of your organization: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone: * - Country - Area code Phone number
Fax: - Country - Area code Fax number
Email address: *
Website URL:
Section 2 of 3: Organization Details
Geographical area(s) covered:

Please describe the geoagraphical area where you operate. Control-X has many distributors around the world, many of them cover part of a country, while others work in several countries or states.
Additional information:
Year company established Tax ID Estimated annual sales revenue # of full-time employees in X-ray department

This information is optional, but helps us process your application.
Section 3 of 3: Details of current activity
What type of equipment do you currently distribute and/or service?
RF Radiological room Chiropractic Veterinary Direct Digital Radiography (flat panel or CCD) Other (please detail) X-ray manufacturers currently represented
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