Fill out the following application and submit to HARC for new Dealer Accounts. Dealer pricing is provided for those businesses purchasing HARC products for resale. The account must have a federal tax ID number.
Online orders may be prepaid by credit card - American Express, VISA, MasterCard, or Discover. These orders will qualify for the 5% cash with order discount. If you wish to apply for as open account, it is necessary to fill out a credit application. Call HARC Customer Service at 800-GET-HARC to do this.
Please provide the following account information:
Name Title Organization Street address Address (cont.) City State/Province Zip/Postal code Country Phone FAX E-mail URL
Enter your organization's Federal Tax ID# in the space provided below.
What type of organization is this (hearing aid dealer, hospital clinic, rehab organization, etc.)?
Who is the contact person for accounting matters?
Name
The account certifies that purchases will be made for the purpose of resale in:
State Sales Tax License #