Credit Application for New Customers

Thank you for your recent inquiry into becoming Dynarex Distributor Partner. Please complete the following credit application for our Finance Department.
Along with your completed credit application, please email/fax your Resale Certificate and 3 Credit References at ( / 845-365-8229 Attn: Heidi)
If you are an International Distributor, please fill and sign our Non-Disclosure Agreement.
If you are a Candian Distributor, please fill and sign our Canadian Distributor Agreement.
If you are requesting a credit line over $5,000, please include financial statement as well. Purchases must exceed $5,000 annually to qualify as an authorized distributor.
Your interest in Dynarex is appreciated and we look forward to serving you.


DISTRIBUTOR CREDIT APPLICATION (Must be completed in full)

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