If you are interested in becoming an AMEDS distributor member, please fill out the following questionnaire and we will contact you by phone.
Thank you for your interest in our AMEDS group.

AMEDS
PROSPECTIVE MEMBER PROFILE
                   
Company Name:
Mailing Address:
City: State:   Zip:
Contact Person: Title:
Contacts Other: Title:
Phone Number:
Fax Number:
E-Mail Address:
Approx. Annualized sales for the last 12 months:
% LTC:
%HHC:
% Other:
What geographic area do you cover? (States or Partial states):
Do you belong to any buying groups?:
If so, which ones:
Are you considered a full service distributor?:
How many SKU’s do you offer?:
Your comments please:

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