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.


Use your email for your Username. Select and make note of your Password.
Email/Username:	*
Password:	*
This email address is the primary communications method for all information from Hygenic Corporation. If this email address is reported as invalid, your access to the Dealer website will be suspended and you will not have access to important communications until you supply a new primary email address. For this reason, we require that you provide an alternate contact email address in the field below.
Alternate Email:	*

First Name:	*
Last Name:	*
Company:	*
Address1:	*
Address2:
City:	*
State:	*
ZIP Code:	*
Country:	*
Phone:	*
Toll Free Phone:
Fax:	*
Website:

Biofreeze or Thera-Band Account Number (if known):


I have personally read, agree to abide by and comply with the current Guidelines, Terms & Conditions (T&C) Policy, Trademarks/Trade Dress Usage and Minimum Advertised Pricing Policy (MAPP) of The Hygenic Corporation. [CLICK HERE TO VIEW]
	I Agree *
I acknowledge that I am the authorized representative of the aforementioned company and agree that said company, its agents & representatives will abide by and comply with the current Guidelines, Terms & Conditions (T&C) Policy, Trademarks/Trade Dress Usage and Minimum Advertised Pricing Policy (MAPP) of The Hygenic Corporation. Yes No ( If ‘NO’, please provide the name and email address of the authorized representative below.)
Name:
Email Address:



For help and assistance completing this form » CLICK HERE «