Ordering & Credit / Dealer Application Forms

Please download this form and fill in your company details along with the item(s) and quantities that you are ordering.

Costs vary with quantity ordered – Contact us for more information

All orders are final. No returns on PPE items.

All PPE items require payment with order.

Your completed order should be sent to info@factory-direct-medical.com or it can be faxed to: 416-739-7171.

This form is to be used for Dealer / Credit Application

Please download this form and fill in the relevant details.

If you have any questions about this form, please contact us.

Your completed appliction form should be sent to info@factory-direct-medical.com or it can be faxed to: 416-739-7171.