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Wholesale Account Request

We are currently accepting applications for a limited amount of wholesale accounts.

Please email the information below to sales@medicalsupplysurplus.com. Once your account has been approved, you will receive an email from our customer service department with instructions on how to place your wholesale orders. If approved, Please allow 1-2 business days for account creation. 

**There is a $500.00 minimum order amount for all wholesale orders. No Exceptions. 

Information Needed:

_________________________________________________________________________

Business Name:

Business Email:

POC Name:

Ship to Address:

Bill to Address:

Business EIN Number: 

If you are tax-exempt, please send a copy of your tax exempt form in the email.