Simply Therapeutic Supplies Inc - Quality Canadian Massage Therapy Products

Thank you for your interest in registering as a distributor with Simply Therapeutic Supplies Inc. WHOLESALE PRICING IS AVAILABLE ONLY FOR OUR LINENS AND POSTCARDS. Please view our TABLE AND CRADLE COVERS, SHEETS AND PILLOWS, and CLINIC POSTCARDS BEFORE COMPLETING THIS FORM. Access to the wholesale pricelist for linens and postcards is limited to massage therapy and/or healthcare supply companies/distributors and we require a minumum of 3 trade references with contact names and phone numbers. Upon verification of the information you provide, we will send you a username and password to access our wholesale pricelist. You may also request wholesale pricing over the phone by calling 604-207-1797.

I. Business CONTACT Information:
01. buyer/owner's full Name:	[*]
02. business Name:	[*] If opening soon, enter "new store"
03. type of clinic/business:	[*]
03. Street Address:	[*]
04. City/Town:	[*]
05. province/state:	[*]
06. country/territory:	[*]
07. Bus Telephone:	[*] please use the format ###-###-#### within canada/usa
08. buyer's email address:	[*]
If available, please provide the following information:
09. Fax Number:	please use the format ###-###-#### within canada/usa
10. business web site address:
II. US CUSTOMS INFORMATION:
11. US Tax ID Number or EIN:	Required by US Customs when shipping to the United States from Canada.
III. SUPPLIER/REP TRADE REFERENCES:
Please list 3 suppliers/wholesalers you currently purchase from or have purchased from in the past. if you are opening a new business, list at least 1 supplier/rep you have already approached who can identify your company.
[wholesale supplier 1]
12. company/supplier:	[*]
13. rep telephone:	[*] please use the format ###-###-#### within canada/usa
14. rep/contact name:	[*]
[wholesale supplier 2]
15. company/supplier:
16. rep telephone:	please use the format ###-###-#### within canada/usa
17. rep/contact name:
[wholesale supplier 3]
18. company/supplier:
19. rep telephone:	please use the format ###-###-#### within canada/usa
20. rep/contact name:
IV. OPTIONAL ADDITIONAL INFORMATION:
21. How did you find our web site?
22. If you found us with a search engine or directory, please specify which one:
V. TERMS OF APPROVAL:
simply therapeutic supplies inc. reserves the right to verify the information you provide. If you are not a health care supplier/distributor, or if you provide false information or invalid trade references, your registration will be denied. By submitting this application, you are signing up to receive periodic follow-up emails from us. you may opt-out of future emails at any time by emailing us.
I have read and accept the terms and conditions and verify that the information I have provided is accurate to the best of my knowledge. [*]