Dealer Inquiry Form

Thank you for your interest in distributing our products. Our primary goal with our independent dealer distribution channel is to make certain that your long term interest in distributing our products is achieved by ensuring that your distribution plan is one that will result in a long term association. Please tell us a little bit about your business using the form below.
All *fields are required. We will get back to you within 48 hours.

*Full Name:	*Business name:
*Address1:	Address2:
*City, State, Zip:	*Email:
*Telephone:	*Business Tax ID Number:
*Web Site URL:
*What is the nature of your business? What other products do you sell (if any)?
*Do you have a retail location/clinic?
*How do you plan to market our products?
*Which chair models are you interested in?
*Are there any additional comments or concerns you would like us to consider?