The information that you provide in this form will be held in the strictest confidence. Completion of this form in no way constitutes a commitment to MedWOW, nor does it imply that a franchise will automatically be awarded. MedWOW encourages you to share any relevant information and include anything that you believe will make your organization stand out as a potential franchisee. If you are planning to have a business partner as a sub-franchisee, he/she should complete a separate application form.
Please complete the form below. If you do not have some of the information on hand, you may Download a PDF Form and send it completed to or by fax to: +357-22-022509.
Company Information
* Company Name:
* Business type:
* Country:
* City:
* Mailing Address:
* Business Phone:
  -    -   (Ext )
   Business Fax:
  -    -   (Ext )
Company Profile
* Company Description (max 10,000 characters):
* Please explain the scope of your business activities (max 10,000 characters):
* When was your business established?
* How many employees does your business have?
* How many sales persons does your business have?
* Does your business perform telemarketing?
Please indicate your customer segmentation according to the market share and number of customers that each of following segments represent:
Customer Segment
Market Share (1-100%)
Number of Customers
 Ministry of Health
 Public Hospitals
 Private Hospitals
 Veterinary Hospitals
 Dental clinics
 Nursing/senior citizens' homes
 Genecology clinics
 Surgery clinics
 Imaging Centers
Please specify your company's shareholders and their shareholding percentage:
 Shareholder's Name
 Shareholding Percentage (1-100%)
Business Documentation
Please attach business documentation, such as: regulatory approvals, working permits, authority approvals, partner contracts, etc
Note: This information will be kept confidential
Please attach a statement with your 2007/2008 profit and net income.
Note: This information will be kept confidential.