Primary Care Catalogue

Web Ordering Account Setup Form http://medicalmart.partnerconnects.com/

TogetherImproving Lives

Customer Account Number

Customer Account Name Main Contact Full Name Main Contact Email Address Password Requested (if not specified a default will be assigned) Territory/Sales Rep

Administration Use Only

Facility Name Application Id Interchange Id

TELUS-UP

Please consider signing up for our monthly newsletter Specials www.medimart.com/subscribe

5150 SpectrumWay, Mississauga, ON, L4W 5G2 [t] 905 624 6200 [f] 905-624-2848 www.medimart.com

6200 Cantay Rd., Mississauga, ON, L5R 3Y9 [t] 905 624 6200 [f] 905 624 2848 www.medimart.com

Web www.medimart.com Email cs@medimart.com

Toll Free Phone 1.800.268.2848 Toll Free Fax 1.800.563.6937

61