Reseller / Professional Form

Welcome! You have chosen to set up a Reseller / Professional Account. This account will apply a reseller price for all items. Pro Therapy Supplies will dropship at no extra charge. Please note there are additional discounts available for bulk orders. If you have any questions, contact us at 1-800-883-0368.

Please fill out the information below. A representative will contact you within 24 to 48 hours to finalize your account.

Your Personal Details

ResellerForm
First Name *
Last Name *
Email Address *
Phone Number *
Alt. Phone Number
Fax Number
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Company Details

Company *
Website (Optional)

Address Details

Main Address *
Address 2 (Optional)
Address 3 (Optional)
City *
State *
Zip Code *
Country *
Tax Exemption # (If Yes)

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