Become a Black & Black Distributor

Thank you for your interest in becoming a distributor for Black & Black Surgical. To allow us to learn more about your company, please fill out the form below completely.

All form fields are required.

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Distributor Profile Information
Principal Contact Information
Business Stats
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Product Lines / Specialties

Please tell us the current product lines you are selling. This information is required so we can better work together.

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Please use the area below to tell us your experience in the Plastic and Reconstructive market (include products, procedures, accounts, etc.)