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http://www.hmeproviders.com/templates/examples.html
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Any specific colors you would like to use:
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Select the categories you would like displayed on your online catalog:
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Access Ramps
Allergy Care
Asthma & Aerosol
Bathroom Safety
Beds
Blood Pressure Products
Breast Pumps
Compression Hose
Diabetic Supplies
Foot Care
Hot & Cold Therapy
Incontinence Items
IV Supplies
Lift Chairs
Lifts
Light Therapies
Mattress & Positioners
Orthopedic Care
Oxygen Therapy
Personal Wellness
Power Wheelchairs
Rehab
Rehab Pwr Products
Scooters
Stethoscopes
Suction Therapy
Thermometers
Walking Aids
Wheelchair Carriers
Wheelchair Seating
Wheelchairs
Select the manufacturers you would like displayed on your online catalog:
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Access Industries
Acorn
Apollo Health
Battle Creek
Bird and Cronin
Blueair
Bruno
Complete Medical
Dana Douglas
Drive Medical
Evolution Medical
EZ Smart
FLA Orthopedic
Golden Tech
Harmar
Health Craft
HDI
HMD BioMedical
Leisure-Lift, Inc.
Invacare
Medela
Mabis
Obus Forme
Nova
Otto Bock
Omron
Permobil
PikStik
Polymer Concepts
Prairie View Industries
Pride Mobility
Resmed
Respironics
Roche
Roho
Salk
SeNova
Shoprider
Silver Star Mobility
Standers, Inc.
Sterling Stairlifts
Summit Stairlift
Sunbox Co.
Therasense
Sunrise Medical
VPI
Main goal of the website with the following choices:
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Informational about your company
Informational about the products you carry
Local sales
National sales
/ Other :
Do you currently own a domain?
Would you like to purchase a new domain? If so, please provide some possible choices and we can let you know which one is available:
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Do you have email currently set up with your existing domain?:
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No
Would you like to set up new professional email accounts?:
[Add More Accounts]
1.
Email Address:
Password:
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Email Address:
Password:
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Email Address:
Password:
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Email Address:
Password:
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Email Address:
Password:
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Email Address:
Password:
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Email Address:
Password:
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Email Address:
Password:
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Email Address:
Password:
Who is the contact person for website setup/questions?
What is the best way to contact them?
Who is the contact person for billing?
What is the best way to contact them?
Special instructions/comments or questions?:
Dealer Payment Method:
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Visa
American Express
Discover
Check
MasterCard
/ Check #:
Name as is appears on the card:
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Credit Card Number:
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Expiration Date:
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Statement Address:
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City:
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State:
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Zipcode:
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Please check your preferred monthly payment method for this account:
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I select to have the monthly fee charged to my credit card on file:
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I select to have the monthly fee charged automatically debited from my checking account:
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