714-632-1012

Dealer Application

Please find our Dealer Application, MAP Policy & the required W-9 Tax ID form.

Please include your tax-exempt or resale certificate if applicable. Thank you for your interest in our company and we look forward to mutually beneficial business relationship.
Please forward your opening Purchase-Order to Amy Yamashiro our Customer Service Manager @ ayamashiro@medsurface.com or via fax to 866-578-6072.

If you have a question regarding the attached form please call Amy at 714-632-1012.

iStock_000012115830_Large