Contact request

You would like to find out more about pfm medical’s products and services? Please describe your inquiry as detailed as possible using the form below.

Inquiry

My enquiry*

I have a question regarding pfm products and services.

I would like to receive an offer.

Please call me.

I would like to make an appointment.

I would like to become a retailer for pfm medical.

Request for quotation

Customer ID

Please fill in the products you would like to receive an offer for. Note the product name, a reference number if available and the requested quantities.

Product 1

Product 2

Product 3

Product 4

Product 5

Call back request

Preferred date for return call

Preferred time period

Phone*

We strive to call you at the specified time. However, we cannot guarantee this.

Appointment request

You may note your preferred week. One of our sales colleagues will get in touch with you as soon as possible, to arrange a visit. Please note: we cannot guarantuee an appointment for the requested week.

Preferred week

Contact details

I am

Salutation*

Title

First name

Last name*

Company / institution

Postcode*

E-mail*

Telephone

Website

Please choose the country in which you are using or would like to receive our products.

Country*

Message*

Please describe your enquiry as detailed as possible - if applicable with product name, product details and quantities.

Message

Upload PDF (max. 5 MB)

Data Privacy

Declaration of consent*

I have read the Data Privacy Statement and consent to my personal data being processed according to this statement.

To the Data Privacy Statement

In order for us to stay in contact with you, we also ask for your marketing consent.

Marketing Consent

Furthermore, I agree that the personal data I have provided may be collected, stored, processed in accordance with the provisions of the EU General Data Protection Regulation and used for the purpose of advertising to me about products, services and corporate information of pfm medical ag, its subsidiaries and/or sales partners, information about workshops and congresses.

I have been informed that the processing of my data is on a voluntary basis and that I can refuse my consent without detrimental consequences for me or withdraw my consent at any time to pfm medical ag by mail (Wankelstraße 60, D-50996 Köln) or e-mail (datenschutz@pfmmedical.com).

I understand that the above data will be stored for as long as I wish to be contacted by pfmmedical. After my revocation my data will be deleted. Further storage may take place in individual cases if this is required by law.