Sell Our Products

GivMohr Corporation offers discounts, training and support to resellers who stock our products. If you are interested in adding GivMohr products to your store, please fill out and submit our reseller application form below. Once we review your information, we will contact you with any questions and let you know if you are approved.

Notes:

  • Required field names are followed by an asterisk (*).
  • Check the reCAPTCHA box at the bottom to verify that you a real person.
  • Once your form is successfully submitted, it will be cleared and there will be a confirmation message at the bottom.

Required Company Information

Company Name*

Year Business Started*

Mailing Address*

Web Site*

Required Contact Information

Contact Name*

Contact Email*

Contact Phone*

Other Company Information

Credit Cards Accepted:
American Express
MasterCard
Visa
Discover
All
Do not accept credit cards

How did you hear about us?

What medical products are you currently reselling?

How many slings do you expect to sell per year?

How do you plan to market the GivMohr Sling?

Other Information

Fax

Federal Tax ID (US Companies)

NM CRS Number (New Mexico Companies)