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By clicking "I Accept" and submitting this form, you acknowledge that you have read, understand, and agree to abide by the Terms and Conditions governing the use of www.quickmedical.com.

Additionally, you agree to work with QuickMedical as a contracted distributor for Amerinet and/or Health Resource Services. Pricing is to be negotiated locally, and is subject to product availability.

Moreover, you agree that the information you have provided is accurate to the best of your knowledge, you have the authority to submit that information, and that by clicking "I Accept", QuickMedical has your permission to use that action as an electronic signature in lieu of a physical version.
     
You will receive an e-mail shortly confirming your request, and another within three business days to confirm your membership.
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