Are you interested in selling Orange Standard scrubs in your retail store?

Please fill out the form below for more information. After completing the form, click on the Submit button at the bottom of the page.

BUSINESS NAME AND ADDRESS
Store Name*
Address Line 1*
Address Line 2
City*
State/Province*
Zip/Postal Code*
Country*
Is this a commercial account?
 
CONTACT INFORMATION
Contact
Title
Phone No.
Email Address*
Fax

BUSINESS INFORMATION
Type of business
Uniform Store Medical Supply Embroidery
Gift Shop E-Commerce Mobile/On Site
Other

Number of store locations:
Number of Years in Business:
Do you have a website for your business?
If yes, What is your website's URL?
Do you carry inventory?
What other lines of uniforms do you carry?
 
Where would you sell our products?*
Retail store location(s)
Website/Online store
Catalog sales
Hospital shows
Other

How did you hear about our products?:
 
Additional Comments:
 
Please review the information above and then click on the Submit button