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ABOUT US SDS SHEETS ADVOCACY 1.800.442.1205 QUICK ORDER BECOME A CUSTOMER SIGN IN Forgot Password? Products Brands GO New Account * Required Company Name * Address Line 1 * Address Line 2 City * State* Select State Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip * Main Company Phone * Fax * Ordering Contact Name * Ordering Phone/ext.# * Ordering Contact Email Order Delivery Name * Order Delivery Email Invoice – Fax# / Email A/P Contact * A/P Contact Phone/ext.# * A/P Contact Email * Administrator * Administrator Email Address * Additional Notes/Request Sales Rep Information How did you Hear About Geriatric Medical Online search Industry Colleague I saw your truck Trade Show Other : Do you have a sales rep? (If Yes, please list name) Select Seles Rep Yes No What is ordering frequency? Weekly Bi-Weekly Monthly I Just need to Place a one time order Other : What products are you most interested in? Medical Paper Equipment Other : Credit Application Form Tax Exempt * Select Tax Status Yes No If Tax Exempt please choose the tax exempt file or email tax exempt form to NewAccount@gerimed.com / tax@gerimed.com CHOOSE FILE Bank References: Name * Fax Number * Account numbers/Bank Contact Person * Trade References: Reference #1 Name * Fax Number * Account numbers/Contact Person * Reference #2 Name * Fax Number * Account numbers/Contact Person * SUBMIT APPLICATION Return Policy Holiday Calendar Contact Us Enter your email address to subscribe to our newsletter SUBSCRIBE Copyright © 2021 Geriatric Medical and Surgical Supply, Inc. All Rights Reserved. Please insert your copy into this space. ACCEPT COOKIES