New Account Application

Thank you for your interest in becoming a Teleflex customer. We look forward to the opportunity to serve you.
To comply with Federal and state regulations, we require the following documentation to be submitted with every application:

  • License Information
  • W-9 and Tax-Exempt Certification (if applicable)
Applications for Credit/Terms must also 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 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

Company Info
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 checkboxes to acknowledge the following:
Trade References
No personal references will be accepted. Cardinal, 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 appropriate box below and provide copy of W-9 in all cases and corresponding exemption certificate, if required)

Purchaser is a taxable entity (W-9 form required)
Purchaser is an Exempt organization: please specify below (W-9 and correlating exemption certificate required)

IMPORTANT: W-9, Tax Exempt Certificate (if applicable), Initial Purchase Order and License Information are all required documents. Teleflex products contain an RX label and as a result Teleflex now requires all customers to produce a valid state and/or federal license or registration that authorizes receipt of prescription devices. Missing documents will cause delays in account setup.

Forms with more than 20 MB of attachments may have trouble e-mailing successfully.

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

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