Dealer Account Application

01

Contacts

Owner / principalRequired

Purchasing / buyerWho places orders

Accounts payableWho receives invoices

03

Business type * — select all that apply

Where you sell

Brick & mortarOwn websiteAmazonOther marketplace

Selling on Amazon, eBay, or another marketplace requires written authorization from us to protect MSRP.

Products of interest *

Single GripBC201Telescoping GripBC500MTile GripBC600

Estimated annual purchases (USD) Anticipated first order date

04

Taxable Exempt / resale

Freight: all orders ship from Bridge Medical. Freight and handling are added to your invoice.

05

We don’t offer credit terms. Payment is due in full on shipment by ACH, credit card, or check. ACH or card is preferred.

Preferred payment method *

ACH (preferred)Credit cardCheck

!Please don’t enter card or bank account numbers here. We’ll send ACH remittance details or a secure card payment link with your first invoice.

06

Payment is due in full upon shipment by ACH, credit card, or check. No open account or credit terms are extended. Orders may be held until payment is received.
All sales are final. No merchandise may be returned without a Return Authorization (RA) number issued by Bridge Companies, Inc. Per our returns policy, return shipping costs for product deemed non-defective are the customer’s responsibility.
If it becomes necessary to bring suit or employ a collection agency to recover any amount owed, Customer agrees to pay, in addition to the amount due, all costs of collection including reasonable attorneys’ fees.
Customer agrees to notify Bridge Companies, Inc. in writing of any change in ownership, legal name, address, contacts, or sales tax status.
Customer authorizes Bridge Companies, Inc. to verify the information provided, certifies that it is true and complete, and agrees to the foregoing terms, intending to be legally bound.

Typed signature (full name) * Title * Date

I’m authorized to sign for this business, the information above is true and complete, and I agree to the terms and conditions above.