Purchase Order Credit Application
This credit application must be filled out in its entirety to receive credit approval for all new purchase orders for Cevi Med. The approval process can take up to 2 weeks depending on credit history.
If you need to make any changes to your application after submission, a new application form will need to be completed and the approval process will restart. Please call (833) 238-4633 if you need any additional assistance.
All provided information is kept confidential and will only be used to determine credit approval. The name and photo associated with your Google account will be recorded when you upload files and submit this form.
The following requirements must be met to receive credit approval for all new purchase orders:
1. The customer application below is filled out in its entirety
2. The signer of the customer application submits a current W9 form
3. The complete order requested is submitted
4. All completed documents are sent via email, fax, or mail
○ Email: email@example.com
○ Fax: 833-238-4633
○ Mailing Address: 1351 S Leavitt Ave #104, Orange City, FL 32763