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To set up a customer account with Net 30 day terms (subject to credit review and approval), please fill out the application form below. Filling out an application is easy and usually takes less than 10 minutes.

If you have any questions, please contact our corporate offices at 800-828-8008. Or email us at [email protected]

* All fields marked with an asterisk are required to be filled out before the form can be submitted.
Business Information






*Is your SHIPPING address different from your BILLING Address?



If you have more than one shipping address, please email your sales representative a list of your shipping locations







*How do you prefer to receive invoices?

Mail invoice to billing address above
Trade References
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*Do You Qualify For Tax Exemption?

If yes, please send us a copy of your sales tax exemption certificate:
Email: [email protected]

*Do You plan to order Rx items?

If yes, please email us a copy of your Physicians license.
Email: [email protected]

*Do You plan to order controlled substances?

If yes, please email us a copy of your DEA license.
Email: [email protected]

Do You have any GPO affiliations?

*I accept Bell Medical Supplies Terms and Conditions?

*Please send me information about discounts, promotions & new products.
(We respect your time and will not clutter your inbox)



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800-828-8008
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