NEW ACCOUNT FORMS
Whether you are interested in becoming a reseller or you are with a healthcare facility, setting up an account could not be easier.
For credit card purchases, simply download and complete the Customer Profile Form and return it along with your W9 Form.
* If you would like to set up a terms account, download, complete, and return the Credit Application along with the Profile Form and W9.
Return to firstname.lastname@example.org or by fax at 601-353-0411.
Please use New Account Setup in the Subject Field or Attention Line.
For questions or additional information, call 601-353-3193 ext.215 or 800-890-5113 ext.215.
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