Wholesale Account Application

Thank you for your interest in establishing wholesale terms with Bridge Global Health. Please complete as much of the information below as you can. We’ll review verify your information promptly and provide order instructions.

For immediate assistance, please contact Jimmy Hollowed at jimmyh@bridgeglobalhealth.com

1Company Information
2Licensing Information
3Accounts Payable
4Shipping Information
5Agreement Review
Contact Name
Company Mailing Address