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JTECH Medical will be closed Thursday, November 23, 2017 through Sunday, November 26, 2017 for the Thanksgiving holiday and from Saturday, December 23, 2017 through Monday, January 1, 2018 for the Christmas holiday.

Normal business hours will resume on Tuesday, January 2, 2018.

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Submit Dealer Application

To apply to become a dealer follow these steps...
  1. Complete the online application submission form.
    You may also download and fax your application to us at (385) 695-5001.
    Dealer Fax Application
  2. JTECH Medical will review your application and you will receive an email response with our decision within 10 business days.

Full Name(*)
Please type your full name.

E-mail(*)
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Phone(*)
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Fax
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Company Name(*)
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Put N/A if not applicable

Tax ID# / Social Security#(*)
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Enter your Website(*)
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Put http://jtechmedical.com if not applicable

Address 1(*)
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Address 2
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City(*)
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Country(*)
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Select your state(*)
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Zip Code(*)
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Postal Code(*)
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Primary Contact(*)
Please type your full name.

Primary Contact E-mail(*)
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Primary Contact Phone(*)
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Alternate Contact
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Alternate Contact E-mail
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Alternate Contact Phone
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AP Contact(*)
Please type your full name.

Put N/A if not applicable

AP Contact E-mail(*)
Invalid email address.

Put dealer@jtechmedical.com if not applicable

AP Contact Phone(*)
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put 000-000-0000 if not applicable

 
Number of Sales Representatives(*)
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Number of Sales Offices(*)
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Years in Business(*)
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Average Annual Revenue(*)
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Distribution(*)

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Is your company considered:(*)

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Other Company Type(*)
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Geographic Service Location:(*)

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Regional States\Providences Served(*)
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International Countries Served(*)
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PrimaryMarket(*)

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Other Primary Market(*)
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Submarkets Served(*)

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(Check all that apply)

Other Submarkets(*)
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Periodically we send emails to our customers notifying them of software updates, new products and promotions. Check This box if you would like to opt out of receiving these updates.

 
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You will receive a written decision via email within 10 business days of the date of your application.

We look forward to the possibility of working with you!

Dealer Support Services

Toll Free: (800) 985-8324
Phone: (385) 695-5000
Fax: (385) 695-5001

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