New Account Application

Thank you for your interest in becoming a Teleflex customer. We look forward to the opportunity to serve you.
Applications for Credit/Terms must provide:

  • 3 Trade References
  • Initial Purchase Order
Once you have completed the application with the required documents, please select submit at the bottom of the application. Incomplete applications will delay processing. For questions regarding your application, please contact New Accounts at newaccounts@teleflex.com. You will not be able to save this form for completion at a later time. Supported Browsers for completing the application: Safari, Internet Explorer & Google Chrome

All fields indicated with an asterisk are required fields

Company Info
Billing/Shipping
Click here if Shipping Address is same as Billing Address
Accounts Payable Information
Please check here if you prefer to receive your invoices electronically.
Please check here if you prefer to receive your statements electronically.
Customer Identification Information
Use checkbox to acknowledge the following:
Trade References
PLEASE NOTE:
No personal references will be accepted. Cardinal Health, McKesson, Medline, Medtronic, and Owens & Minor will not provide information to Teleflex so please refrain from using them as a reference on the application.


Sales Information
Sales Tax
All sales are considered Taxable, unless a Resale or Tax Exemption Certificate is completed, signed and returned for each Ship to Location. To ensure that none of your orders ship as taxable, please return the completed Resale and Tax Exemption Certificate with your completed Credit Application.
Purchaser Sales/Use Tax Declaration

Purchaser hereby certifies to the seller that: (please check the appropriate box below)

Purchaser is a taxable entity
Purchaser is an Exempt organization: (please attach tax exemption certificate below)
Attachments

IMPORTANT: Initial Purchase Order and any applicable qualifying certificate (Tax-Exempt Certificate, Establishment License, etc.) are required documents. Missing documents will cause delays in account setup.

Forms with more than 20 MB of attachments may have trouble e-mailing successfully. If your total document size is greater than 20 MB please compress some of the documents into ZIP files.

Note: The undersigned understands and agrees that if he/she used the tangible personal property other than as stated above or for any purpose which would not exempt the sale under the noted State’s Acts, he/she becomes liable for the tax.
Contact Information

Please list who you wish to be contacted with the results of your application

For questions regarding your application, please contact New Accounts at newaccounts@teleflex.com

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