Partner Request Form

Want to be a part of the Urgent First Aid^® Family?
We are always interested in bringing new, quality Distributors into the fold!
We support Stocking Distributor Partners, Drop Ship Distributor Partners, First Aid Services, and we develop and manage production of entire product lines for Partner Distributor Brands.
We’re flexible and creative, and if you are looking to step into the marketplace or expand your current operations, fill out our online Distributor Application below and one of our helpful Distributor Support Representatives will get back to you shortly!
(Minimum initial order for Distributorship $5000, with a $25,000 annual commitment.)

Fill out and submit the form below. Or download a printable form and Fax it to: 1 (760) 944-2959

Become a Partner

Required fields marked by: *

Company

Contact

Street Address

City

State

Postal Code

Phone Number

Fax

Website

Business Type:

Year Established

Tax ID No. or Resale No.

Principal Officer

Accounts Payable Mgr:

Purchasing Manager:

First Aid Rep:

List any buying groups your company is affiliated with.

Do you print a catalog?

Projected Annual Sales

Credit References

Bank:

Branch:

Bank Contact:

Bank Phone:

Account No.

Type:

Account No.

Type:

Trade Reference:

Address:

Phone:

Fax:

Trade Reference:

Address:

Phone:

Fax:

Trade Reference:

Address:

Phone:

Fax:

Upload your Business Liscense, Resale Certification, or Sellers Permit.

Upload File No file choosen (Please upload a .pdf)

Terms & Conditions

The above information is given for the purpose of obtaining a Distributor account with Urgent First Aid^® and is warranted to be true. We agree to pay all invoices in accordance with your regular terms of Pre-payment (unless otherwise noted). Should suit or collection action be instituted in collection of our debt, we hereby agree to pay all reasonable collection costs, expenses, attorney fees, and court costs incurred in the enforcement of the obligations of the undersigned.
We hereby authorize our credit references to release any information necessary to assist in establishing a line of credit with Urgent First Aid^®.
In the case of Sole Proprietorship or a Partnership, we authorize Urgent First Aid^® to obtain an individual credit report on the Principals of the applying business. This information will be used solely as a factor in Urgent First Aid^®’ credit decision pertaining to this applicant.

Accept Terms & Conditions?

Partner Request Form

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