Become A Distributor

Distributor Inquiry Form

Does your business sell to professional healthcare provider facilities like hospitals, surgery centers, nursing homes, dental practices, or doctor’s offices? NDC is a master wholesale organization offering an array of services to support healthcare distributors.

NDC only sells to established resellers. Residential addresses are not accepted. State tax exemptions/resale certificates will be required for every state where your company ships merchandise.
Note: This is not an application.

First Name*

Last Name*

Company*

How did you learn of NDC? Were you referred by a manufacturer?

Phone*

Fax

Email*

Street*

City*

State/Province*

Zip*

Square Feet of Office Space:

Warehouse Space:

Website*

Year Established*

Branch Locations

Please list city, state, zip code, and square footage of each location.

Branch Office Location 1:

Branch Office Location 2:

Key Contacts / Personnel

CEO/President*

Operations Manager*

Purchasing Agent(s)*

Sales Manager*

Marketing Director*

Accounts Payable*

Number of Sales Personnel*

No. Inside Sales*

No. Outside Sales*

Employees

No. of Delivery Vehicles

Annual Revenue*

Territory Regions

GPO Affiliations

Top Three Vendors*

Captcha Verification

*Required