We sell directly to distributors as well as end-users such as hospitals, nursing homes, etc. In order to view pricing/purchase you must submit the application below for our consideration.

Business Information
Business Name
DBA
Tax ID Number
Years In Business
Approx Annual Sales
Type of Business
Venue of Business	-- Please Select -- Medical Dental Nursing Home Hospital Wound Care Center Physician's Office School Brick & Mortar Storefront E-Commerce Both Other Other
What facilities, if applicable do you service?	Hospital Nursing Home Home Health Agency Wound Care Center Other
Website Address If Applicable
Contact Information
Contact Name
Title
Email Address
Phone
Fax
Communication Preference	Phone Email Mail Fax
Mailing Address
City, State & Zip
Shipping Address
City, State & Zip
General Information
Please describe your store and reason for application (ie: become an approved retailer or learn more about our line)
Please list the top five other brands you carry
Comments for General Consideration

Please note all retail applications must be reviewed for acceptance. We have certain internal standards and contracts in place that prevent us from accepting all applicants. Once we receive your application, we will review it in a timely manner and get back to you as soon as possible with the status of your application.