Pricing Registration

*Required Fields

*Name

*Business Phone

*Cell Phone

*Fax


*Email

*Company

*Shipping Address

*City

*State

*Zip

*Billing Address

*City

*State

*Billing Zip

*Pricing Authorization Code


Comments


 
 
 
Please complete this section if you have registered on line via Create Account and would like to complete your account registration online rather than via phone, e-mail or fax with the applications found under Forms.
 
Upon completion and getting your account setup, we will contact you to let you know your account is ready for your online ordering and viewing.
 
Lastly, we thank you for trusting in us for being your resource for your medical supply needs.
 
Enjoy

 

 

 

 

 

 

 

 


Alpha Medical Equipment, Inc.
P.O. Box 88
Zimmerman, MN 55398



(763) 263-8576 - Phone
(763) 263-8577 - Fax
(763) 486-2886 - Cell




©Alpha Medical Equipment, Inc. 2016
All Rights Reserved