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OPEN AN ACCOUNT WITH US

Not a healthcare professional?

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Apply for an account with BracePoint Medical Inc.(formerly C. Turner Medical Ltd.)

For Canadian healthcare professionals only

PERSONAL INFO

Name *

First

Last

Title *

Clinic/Business Name *

Sales Rep

ADDRESS

Billing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Is your shipping address the same as your billing address? *

Shipping Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

ADDITIONAL INFO

Phone *

Fax

Website / URL

Email *

Years in Business *

Payment Contact Person *

PAYMENT DETAILS

Will you be using a Credit Card for your purchases? *

Would you like to fill out credit card authorization form? *

Please note that if you choose "No", you can download Credit Card Authorization Form by clicking on a link in your confirmation email and download a PDF version. You can then fill it out, scan it and send it as email attachment or fax it to us.

TRADE REFERENCES

If not using a credit card, please fill out trade references.

Business Name *

Contact Name *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Fax

Completed by *

Date / Time *

CREDIT CARD AUTHORIZATION

Credit Card Type *

Visa
MasterCard
American Express

Credit Card Number *

3 digit CVC # *

Expiration Date: *

Card Holder Name *

Email address for invoices *

Company Name *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Fax

Keep on file for future orders? *

Yes. I hereby authorize C. Turner Medical Ltd. to automatically charge my credit card with every invoice issued.
No. Please use this card only once.

(I understand that checking the above is an equivalent to my signature)

Todays Date *

How did you hear about us? *

So how did you hear about us? *

264 Bronte St. South, Unit #11
Milton, ON, L9T 5A3

CONTACT

Toll Free: 1-800-661-5329
Phone: (905) 876-0873
Fax: (905) 876-2958
Email: info@cturnermedical.ca

HOURS

MON - FRI

8:30am - 4:00pm

SATURDAY

CLOSED

SUNDAY

CLOSED

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