HOSPITAL 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 Hospital 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 4 bannerstands
-- Includes 1 Literature Holder and 1 Tablecover per order.
Hospital CodeWriter Integrated Bannerstand
Hospital CodeWriter Real-Time Bannerstand
Hospital Critical Care Bannerstand
Hospital Pediatric Bannerstand
Hospital Rapid Response Bannerstand
Hospital See-Thru CPR Bannerstand
Hospital Z Vent Bannerstand
Date needed:
Shipping address:
This Order:
Name:
Ships Direct to Show
Ship to Show Warehouse
Ship to Home Office
Address:
City:
State:
Select One
Alaska
Alabama
Arkansas
American Samoa
Arizona
California
Colorado
Connecticut
D.C.
Delaware
Florida
Micronesia
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Marshall Islands
Michigan
Minnesota
Missouri
Marianas
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Palau
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Virgin Islands
Vermont
Washington
West Virginia
Wisconsin
Wyoming
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.