ZOLL

EMS REGIONAL SHOW APPROVAL
& ORDER FORM

STEP 1 - INFORMATION

Your Name Region
Your Email Your Manager's Email



Event Name Event Dates
Amount To Be Paid:
Check Payable To
New Vendor Form & W9 on file.
New Vendor Form & W9 not on file. I understand that I must have the sponsoring organization complete and hand-sign a W9 and New Vendor information form.
 
(If the amount to be paid exceeds $750, this form will be sent to the Vice President of the EMS Market Segment for approval. The order will NOT be processed without this approval).
 
If applicable, select each market that will be splitting this cost: (TOTAL must equal "Amount To Be Paid")
        EMS $         VENTS $
        HOSPITAL $         TMS $
        DATA $         CPR $
                CMS $
    Territory Manager (s) Attending:

STEP 2 - REQUIRED DOCUMENTATION

A CHECK REQUEST WILL NOT BE PROCESSED UNTIL ALL DOCUMENTATION BELOW HAS BEEN RECEIVED BY TYLER LANNON
BY EMAIL [email protected]
 
- New Vendor Information Form ( click to download )
- W9 Form ( click to download )
- ACH Form ( click to download )
- An invoice or documentation showing the cost, who to make the check payable to, and where to mail the payment.

STEP 3 - ORDER DESIRED EXHIBIT

   
No Exhibit Needed

Bannerstands
-- Choose a maximum of 3 bannerstands
-- Includes 1 Literature Holder and 1 Tablecover per order.
EMS AutoPulse NXT Bannerstand EMS Cardiac Arrest Care Bannerstand EMS EMS and Fire Bannerstand EMS Pediatric Care Bannerstand
EMS AutoPulse NXT Bannerstand EMS Cardiac Arrest Care Bannerstand EMS EMS and Fire Bannerstand EMS Pediatric Care Bannerstand
EMS Respiratory Care Bannerstand EMS Stemi Care Bannerstand EMS Trauma Care Bannerstand
EMS Respiratory Care Bannerstand EMS Stemi Care Bannerstand EMS Trauma Care Bannerstand
EMS X-Series Adv - Advance Your Care Bannerstand EMS X-Series Adv - Real BVM Help Bannerstand EMS X-Series Adv - TBI Dashboard Bannerstand
EMS X-Series Advance - Advance Your Care Bannerstand EMS X-Series Advance - Real BVM Help Bannerstand EMS X-Series Advance - TBI Dashboard Bannerstand


Date needed:
Shipping address:   This Order:
Name: Ships Direct to Show
Ship to Show Warehouse
Ship to Home Office
Address:
City:
State:
Zip:
Phone:

STEP 4 - RETURN SHIPMENT

It is your responsiblity to ship the display back to Downing Displays. A UPS return label is provided in the display case.

DO NOT LEAVE THE DISPLAY IN THE CONVENTION CENTER.

Shipping Address:
ZOLL Medical Corporation
c/o Downing Displays
550 Techne Center Drive
Milford, OH 45150
Display quantities are limited and must be returned immediatley after the show. If it is not returned in a timely fashion, an invoice will be sent to your regional manager for a replacement.

If you have concurrent events, please complete a form for all events needed. Thank you.