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Wholesale Intro Package
Sleep centers and DME's, please complete this form to request a Wholesale Kit
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* Indicates required question
Email
*
Your email
Sleep Center / Company Name
*
Your answer
Your First Name
*
Your answer
Your Last Name
*
Your answer
Title
*
Choose
Ms.
Mr.
Mrs.
Dr.
Sir.
Miss.
The Business Street Address
*
Your answer
Business Street Address Line 2
Your answer
Business City
*
Your answer
State/Province
*
Your answer
Postal / Zip Code
*
Your answer
Country
*
Your answer
Office Phone Number
*
use this format ###-###-####
Your answer
How did you hear about Rematee?
*
Your answer
How many new OSA patients do you see monthly?
*
Choose
~30
~60
~120
>120
Do you currently sell positional products?
*
Yes
No
Other:
What should we send you?
*
Rematee wholesale package with product descriptions, images and pricing
A Purchase Order Form
Required
Submit
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