Medi-Exchange

Supplier Application

Thank you for your interest in becoming a supplier with Medi-Exchange.

The information you provide will assist us in supporting your online business strategies. It will also facilitate Medi-Exchange's global buying community to identify and establish trading relationships with the suppliers community.

Please tell us about your organization.
Fields labelled in red are required.

How did you hear about Medi-Exchange?

Primary Industry:	(fill in if other Business)

Commodity Group:

How many line items does your organization have?

Core Products & Services:

Please tell us how we may contact you.

Fields labelled in red are required.

Primary Contact Email:

Primary Contact Name:

Mr./Ms./Dr. etc.:

Primary Contact Telephone:

Primary Contact Fax:

Company Legal Name:	Business Registration No.

Company Web Site (not including http://):

Designation:

Department:

Street Address Line 1:

Street Address Line 2:

Street Address Line 3:

Street Address Line 4:

City:

Postal (ZIP) Code:

Country:

Preferred Organisation ID:

Company Description (<200 words):

TERMS AND CONDITIONS OF ONLINE SUPPLIER REGISTRATION AT Medi-Exchange

These terms and conditions govern your use and submission of data to Medi-Exchange (the "Site") as a registered listed supplier on the Site.

By clicking the "SUBMIT" button, registering to use, accessing, submitting information or otherwise using the Site, you acknowledge that you have read, understood and have agreed to be bound by these terms and conditions.

IF YOU DO NOT AGREE WITH THE TERMS AND CONDITIONS, DO NOT PROCEED OR ATTEMPT TO USE THE REGISTERED MEMBER FEATURES OF THIS SITE.

By submitting the information on the Site on-line registration form, you agree to the following:

Medi-Exchange reserves the right to edit or remove submitted information for length or inappropriate content. Medi-Exchange reserves the sole and absolute discretion not to display any or all submitted information on the Site.
You grant Medi-Exchange a non-exclusive, royalty-free, worldwide right to reproduce, transmit, use, derive or otherwise display material (including without limitation your company name, trade name, logo or other trademarks) and/or other information submitted by you to the Site, in connection with operation of the Site and/or any and all Site related advertising, marketing or promotional material or communications.
You will comply with the Medi-Exchange General Terms of Use which are incorporated herein by reference.