Supplier Sign-Up Form
Thanks for expressing interest! To request access to the latest list of Vent Maker part shortages, please fill out the details below:
(Note - We request that a single submission be created per organization - additional users can be added below or emailed to help@ventconnect.org)
Company Name *
Please enter the name of your company or organization.
Your answer
Your Name *
Please enter your First and Last name without initials
Your answer
Phone Number *
Please enter your phone number including area code and/or country code
Your answer
Corporate Email Address *
Please enter your corporate email address. This will become your login email for Vent Connect.
Your answer
Please add email addresses (comma-separated) for other individuals at your company who will need access to manufacturer parts shortage lists
Example: name@domain, name2@domain, etc.
Your answer
What is your role within your organization? *
Your answer
Company Website *
Your answer
Your company location *
Required
My company is (select all that apply) *
Required
My company currently supplies parts for ventilators, dialysis machines, and/or pulse oximeters *
My company currently provides operations support (engineering services, manufacturing, fabrications, QA testing etc) for medical devices? *
My company makes/manufactures medical devices and has a product offering that may compete with those from manufacturers on this site. *
Additional Comments
Have additional information or comments for medical device manufacturers and/or Vent Connect? Please include it here!
Your answer
Nondisclosure Agreement (NDA) *
By checking this box, I certify that I have read and agree to the following NDA: https://sites.google.com/corp/ventconnect.org/ventconnect/nda
Required
Terms of Use *
By checking this box, I certify that I have read and agree to the following Terms of Use: https://sites.google.com/corp/ventconnect.org/ventconnect/terms-of-use
Required
Google Account Association *
In order to access Vent Connect content, you will need to associate all emails you've entered into this form with a Google Account. Please follow the steps listed in the link below. Skipping this step may result in issues accessing manufacturing information. https://docs.google.com/document/d/11oilTQxqxwexozS-WR4V5n2GRjFc5SPuMYYHLzkhg88/edit?usp=sharing
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