Become a Provider

JOIN OUR NETWORK

Are you interested in supplying HearSmart^TM and Audiofuse^TM products? If you would like to be added to our network of exclusive Providers, please fill out the information below.  We will send you an application form to get started.

We offer excellent wholesale pricing that is based on quantity and recurrent orders.

SEND US AN EMAIL

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CONTACT NAME *

WEBSITE

PHONE *

TYPE OF BUSINESS (example: hearing clinic) *

COMPANY NAME *

BUSINESS ADDRESS (main address if more locations) *

EMAIL *

CITY *

PHONE clinic) locations)

PREFERRED CONTACT METHOD *

• BY PHONE
• BY EMAIL

PROVINCE & POSTAL CODE *

Checkboxes

• CHECK IF MULTIPLE LOCATIONS

MULTIPLE LOCATION PLACEHOLDER

QUESTIONS/COMMENTS *

Submit