Contact Us

Distributor Inquiry Form

Does your business sell to professional healthcare provider facilities like hospitals, surgery centers, nursing homes, dental practices or doctor’s offices? NDC is a master wholesale organization offering an array of services to support independent healthcare distributors. NDC only sells to established resellers. Residential addresses are not accepted. State tax exemptions / resale certificates will be required for every state where your company ships merchandise.
Note: This is not an application

First Name*

Last Name*

Company*

How did you learn of NDC? Were you referred by a manufacturer?

Phone*

Fax

Email*

Street*

City*

State/Province*

Zip*

Square Feet of Office Space:

Warehouse Space:

Website*

Year Established*

---

Branch Locations (please list city, state, zip code, and sq ft of each)

Branch Office Location 1:

Branch Office Location 2:

Key Contacts / Personnel

CEO/President*:

Operations Manager*:

Purchasing Agents(s)*:

Sales Manager*:

Marketing Director*:

Accounts Payable*:

---

Number of Sales Personnel:*

No. Inside Sales*:

No. Outside Sales*:

Employees

No. of Delivery Vehicles:

Annual Revenue*

Territory Regions: --None-- Region 1: Northeast Region 2: Midwest Region 3: South Region 4: West US Canada International US Continental Other All US & US Territories

GPO Affiliations:

Top Three Vendors*:

Primary Market: --None-- Acute Care Animal Health Correctional Facilities Dental Dialysis First Responder Government Home Healthcare Hospice IDN Laboratory Long Term Care Pharmaceutical Physical Rehab Physician Physician/Clinic - General Schools Specialty/Other Surgery Center Other

Primary Subcategory:

Secondary Market: --None-- Acute Care Animal Health Correctional Facilities Dental Dialysis First Responder Government Home Healthcare Hospice IDN Laboratory Long Term Care Pharmaceutical Physical Rehab Physician Physician/Clinic - General Schools Specialty/Other Surgery Center Other

Secondary Subcategory:

Additional Market: --None-- Acute Care Animal Health Correctional Facilities Dental Dialysis First Responder Government Home Healthcare Hospice IDN Laboratory Long Term Care Pharmaceutical Physical Rehab Physician Physician/Clinic - General Schools Specialty/Other Surgery Center Other

Additional Subcategory:

Market Segmentation Other Info:

Minority Status: HUBZ - HUBZone Business WOSB - Women-Owned Small Business SDB - Small Disadvantaged Business SDVOSB - Service Disabled Veteran SB - Small Business VOSB - Veteran-Owned Small Business LB - Large Business Minority Business N/A

Store Front: --None-- Yes No

Captcha Verification

Submit

Thanks for contacting NDC!