Supplier Intake Form Application

We're in search of suppliers who can meet demand and specifications to ensure the best quality, cost, and on-time delivery of products for our healthcare partners. Once you've submitted your information, you'll be sent a product submission form which requires your unique supplier ID and email address to submit products. After you've completed the sourcing process, the details you enter here will be shared with procurement teams at hospitals, healthcare associations, and governments. By submitting your information, you agree to allow us to disclose the information you provide to potential buyers, consistent with our mission to connect personal protective equipment (PPE) suppliers to those who need it most--the healthcare providers at the frontline.
Supplier Intake Form
of contact person
Address *
Address
City
State/Province
Zip/Postal
Country
Company Type *
I can provide evidence that my products are manufactured in an approved facility *
Does your manufacturing/supply facility have an export license? *
Can you provide the physical address of your manufacturing/supply facility on request, and are you prepared for it to be physically inspected by agents of the buyer? *
Incoterms for [X] *
Payment terms *
Have you sold medical equipment before? If so, please provide information about applicable references or contract vehicles.
How did you hear about us?
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