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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. (#1 & 2 below)

* If you prefer to set up a terms account, download, complete, and return the Credit Application along with the Profile Form and W9. (#1, 2, & 3 below)

  1. Customer Profile Form

  2. Blank W-9 Form 

  3. Credit Application* 

Return to 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.

                           1.                                                          2.                                                      3.*
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