Dealer Registration

We require all dealers to REGISTER to gain access to this site's resources.

1. Please complete all fields below and click the Register button at the bottom of this form.
2. Once we have confirmed your registration details we will email you confirmation of your activation. You can then immediately go to http://www.performance-health-dealers.com and login.
4. Please remember your email is your username and keep your password safe.

Fields marked with an * are required.

First Name:

Last Name:

Company:

Address1:

Address2:

City:

State:

ZIP Code:

Country:

Phone:

Toll Free Phone:

Fax:

Website:

Use your email for your Username.
Select and make note of your Password.

Email/Username:

Password:

Biofreeze or Thera-Band Account Number:

Company President Name:

Company President Email:

Purchasing Contact:

Purchasing Contact Email:

Sales Contact:

Sales Contact Email:

Accounts Payable Contact:

Accounts Payable Email:

How many telemarketing sales reps do you have?

How many outside sales reps do you have?

What countries outside the US do you sell to?
[If you do not sell to any countries outside the US, please enter NONE in the box below]

What types of healthcare professionals do you market to? [Please select the top 3 or at least 1]

DC	PT	AT
OT	MT	DPM
SPA	OTHER

I have read and agree to the terms and conditions of The Hygenic Corporation Trademark Policy.
[CLICK HERE TO VIEW]

I Agree *

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