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 Enrollment Information

Fill out the fields below to create an account with Suture Express.
Be sure to click the 'I Agree' checkbox for the Confidentiality Agreement at the bottom of the page.
 
 Facility Name:    *
(Contact): First Name:    *
(Contact): Last Name:    *
 Address1:    *
 Address2:    *
 City:    *
 State:    *
 Postal Code:    *
 Phone Number:    - - *
 Fax Number:    - - *
 E-Mail Address:    *
Confirm E-Mail Address:    *
 Password:    *
 Confirm Password:    *

Suture Express Account #:   
(Existing Customers Only)   

Payment Method:    *

     

 
      Facility type: *
 
 
GPO Affiliation?: *
 
Other Affiliation:
*
 

  Estimated Annual Wound
     Closure Expenditures:  

*
 

 

 

Confidentiality Agreement: We agree that any information regarding each other's activities shall not be disclosed to any other person or entity, except as required by law or contractual requirements of manufacturers or unless such disclosure is mutually agreed upon. By Agreeing you authorize Suture Express to contact Johnson & Johnson, Covidien, Teleflex, Applied Medical, and 3M to load your contract pricing and past usage data in order for Suture Express to distribute products to your facilities.

Please note that your payment method selection cannot be changed. The Suture Express standard payment terms are Net 15. Please contact your sales representative for additional payment term information.

If your payment method is credit card, you must place your orders through our website.

There will be a handling fee associated with the use of a credit card upon checkout.
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