Health Management Systems, Corp.

         

We offer the highest quality products for Point-of-Care Testing! 

 

 Make changes to your account

 

If you would like to make changes to an account with Health Management Systems, Corp. please fill out the following form.

USE THE TAB OR MOUSE, NOT THE ENTER, TO MOVE BETWEEN FIELDS.  The enter key will submit the form.  If you hit the enter key prior to completion of the form, use your back button and continue filling out the form.  Click submit or Enter when done.

Account #:
 
*****Enter only the information that needs to be changed or updated*****

Billing Information:

Company Name:

A/P Contact Name:

Address:


City:  State:  Zip: 

Phone:

Fax:

Email:

Shipping Information:  If same as billing check here and move to next section.

Company Name:

Receiving Contact Name:

Address:


City:  State:  Zip: 

Phone:

Fax:

Email:

Other Information:

Purchasing Contact:
Name:  
Phone: 
Email:  

Tax Exempt:  Yes   No  (if yes, please fax tax exempt certificate to (972) 578-9854)

Legal Structure:  Corporation    LLC    LLP    Partnership    Sole Proprietor    Non-Profit

Federal Tax ID #: 
Type of Business: 


    

If you have any questions or problems with this site, please call Health Management Systems, Corp. customer service at 888-300-4672