Wholesale Supplier Registration

In order to obtain access to the wholesale prices you must register your company first with us.
To register please fill out the registration form below,  fax it to 954-455-9407 or email it to patriproducts@gmail.com.
Once you register with our company, we will be sending you the password needed in order for you to log in and obtain the wholesale prices for our products. Or you can simply email us your contact info and your company name and we can email you the list of products and their wholesale prices.

WHOLESALE SUPPLIERS REGISTRATION

Patri  Products, LLC ,  404 N Federal Hwy, Hallandale, FL 33009

Fax: 954-455-9407 / Email: patriproducts@gmail.com

Please fill out this form.

Fax it to 954-455-9407 or email it to patriproducts@gmail.com

*First Name: ____________________________________________

*Last Name:_____________________________________________

*Company Name: __________________________________________________________________________

*Tax ID: _________________________________________________

*Address: _________________________________________________________________________________

*City: ____________________________________________________

*State: ______________         * Zip code: _________________________

*Tel #: _____________________________________________________

* Fax #: ____________________________________________________

*Email: __________________________________________________________________________________

*Type of your business:  ______ Doctor            ______ Medical supply      _______ Store

______ Other, if other what ____________________

*Your business website: ______________________________________________________________________

How did you hear about us?   ____  Friend        _____ internet       ____ website       _____  show

_____ other ________________________