Dealers Only

1.  Create an account.
 

2.  Submit  the form below requesting to be setup in our Online Dealer Group membership. Once you have been verified as a Durable Medical Equipment establishment, you will notified via email and you will be able to view Dealer pricing and calculate freight charges to desired zip code locations when you login. We only ship to Mainland USA.
 

3.  If you are not already setup as an authorized dealer with open terms and would also like to have an open account with terms, just make your request at the bottom of this form and a dealer setup packet will be emailed to you.
 

Note: Dealer applications can take up to 48-72 hours to process.

 


 

 

 

 

 

 

 

 

Company Name:
Contact:
Physical Address:
Add'l Address Information:
City:
State:
Zip Code:
TIN# or EIN#:
Ph#:
Fax#:
Email Address:
Website Address:
I am currently setup as an authorized dealer with terms :


I would like to be sent an application to setup Open Terms:


Comments:
 

 

 

 

 

 

 

 

 

 

Subtotal: $0.00