All fields are required unless marked optional.

Business Advantage Assessment Form


Please complete the following form to initiate discussions for any prospective business opportunity conversations with JAPAN MEDICAL TOURISM INC. (JMT). You will be contacted shortly to acknowledge the receipt of this form and to determine if there is interest in exploring a partnership with your organization. Your privacy is guaranteed.

General Information

 
Subject
If others, please specify
First Name
Last Name
Title
Telephone Number
Email

Partner \ Affiliate \ Provider Contact Information

 
Company Name
Contact Person
Address
Address 2 (optional)
Country
Phone
Email

Your Company Profile

 
Company Website
Year Founded
Number of Employees (optional)
Number of Employees Dedicated to
Medical Tourism, Hospitality Industry, etc.
Description of Customers (Total No. ) (optional)
Previous Year Sales Revenue (optional)
Company Ownership (optional)
Venture Financing (optional)
Basis for interest in
Japan Medical Tourism Inc. JMT
If others, please specify
Commercial Areas of Interest
If others, please specify
Captcha

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

45 + = 53

Complete the equation above.