The following is a list of mandatory requirements and expectations at Aspen Surgical to become a reseller. If your organization meets these, please complete and submit the application in full to be considered as a potential authorized reseller.

Resellers will use commercially reasonable best efforts to purchase during each calendar year products with aggregate price in the minimum amount of $30,000 (the Minimum Purchase Target). Reseller acknowledges that satisfaction of the Minimum Purchase Target is a material obligation necessary to justify Aspen Surgical’s ongoing administrative support of the distribution relationship. Failure to satisfy the Minimum Purchase Target will be a basis for Aspen Surgical to cancel or terminate the reseller.
Resellers shall provide to Aspen Surgical monthly sales tracing reports identifying the end-users to whom Aspen Surgical products were sold. Reports will be submitted electronically by the 10th day of the month following the month that is covered by the report. Failure to satisfy the Sales Trace Requirements will be a basis for Aspen Surgical to cancel or terminate the reseller.
Aspen Surgical requires resellers to have and maintain their own sales force, as well as product inventory.
Reseller is authorized to promote, sell, and deliver products only in the territory comprised of the United States, unless reseller is authorized in writing by Aspen Surgical to sell internationally.

I Agree * Yes I have read and understand the above policies of Aspen Surgical and would like to apply to become an Aspen Surgical reseller.

Business Type *

Describe your business model. *

Specify the geographic regions to which you sell. *

List the Target Markets where you currently sell or plan to sell. *

List the Aspen Surgical products you are interested in reselling. *

Do you currently distribute any Aspen Surgical product categories today? Please list below. *

List other medical devices companies you currently resell. *

Company Name *

DBA, if applicable

Website

Your Email *

Your First Name *

Your Last Name *

Your Phone Number *

Billing Address *

Billing City *

Billing State *

Billing Postal Code *

Shipping Same as Billing *

Shipping Address *

Shipping City *

Shipping State *

Shipping Zip *

Purchasing Contact Name *

Purchasing Contact Email *

Purchasing Contact Phone

Accounts Payable Name *

Accounts Payable Email *

Accounts Payable Phone

Invoice Delivery Email *

Statement Delivery Email

Tax Status * Tax Exemption Certificate MUST be sent to commercialoperations@aspensurgical.com, otherwise account will be charged tax.

Preferred Shipping Carrier

Shipping Account Number

Preferred Shipping Method

EDI/GHX Integrated *

Tax ID / FEIN Number *

Dun & Bradstreet number:

Date Business Commenced

Legal Entity Type

CEO/CFO Name

Preferred Payment Terms *

Bank Name

Bank Phone Number

Bank Email

Bank Address

Bank City

Bank State

Bank Postal Code

Bank Account Type

Bank Account Number

1 Reference Business Name

1 Reference AR Contact Email

1 Reference Account Number

2 Reference Business Name

2 Reference AR Contact Email

2 Reference Account Number

3 Reference Business Name

3 Reference AR Contact Email

3 Reference Account Number

Authorization * Yes I authorize that the information provided in this application is correct and accurate. I give Aspen Surgical Products, Inc. permission to verify the information on this form for credit history and check our references.

Subscribe * YesNo Yes, I would like to receive updates about products & services, promotions, special offers, news & events from Aspen Surgical.

Signature * By typing my name, we the undersigned signify by our order that we understand and agree to Aspen Surgical Products, Inc’s standard terms and conditions. We signify by our signature that we have the legal right to agree to these terms for our company.

Date *

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