How to Become an Össur Customer

To become a new customer of Össur you will need to complete a credit application (see below). You may also call 800-233-6263 for assistance.

1. Business Owner (Sell To)

Please fill out our online credit application as thoroughly as possible so there is no delay in processing (please allow 2-3 days for processing time). Once it has been processed, you will be notified by email with your account information.

Type of Entity*:
Federal Tax ID Number*:
Customer must include a valid tax exemption certificate with the completed credit application; otherwise, tax will be charged where applicable. Please upload using the control here below:
Resale Number (Tax Exemption) *:
Years in Business *:
Name of Prosthetist / Orthotist:
Certification Number:
Type of Business:*

2. Key Management Members and Owners
	Name	Title	Ownership
1*.		*	* %
2.			%

3. Billing Address (Bill To)

Company Name*:
Accounts Payable Contact*:
Email address*:
Purchasing Contact*:
(GLN) Global Location Number:
Phone Number*:		Fax Number*:
Billing Address*:		State*:
City*:		Zip/Postal Code*:

4. Shipping Address (Ship To)

Same as Bill To:
Company Name*:
(GLN) Global Location Number:
Phone Number*:		Fax Number*:
Address*:		State*:
City*:		Zip/Postal Code*:

5. Banking Information

Bank Name*:
Account Number*:
Contact Person*:
Phone Number*:		Fax Number:
Address:		State:
City:		Zip/Postal Code:

6. Credit References

Reference A
Company Name*:		Account Number*:
Phone Number*:		Fax Number*:
Address*:		State*:
City*:		Zip/Postal Code*:
Reference B
Company Name*:		Account Number*:
Phone Number*:		Fax Number*:
Address*:		State*:
City*:		Zip/Postal Code*:

7. Payment Terms with Payment Method and Verification

Selection and Agreement to ÖSSUR Americas offered terms

Note: Select one box as the agreed to Standard Payment Terms and Payment Method – Any changes made to this Credit application without Össur’s prior written consent shall be null and void.

	Net 30 Days Payment Terms with Payment Method by Check or Wire Transfer only By selecting Net 30, you agree to pay ÖSSUR within 30 days after the date of invoice by check or wire
	Credit Card Payment with Payment Method by Credit Card provided with order By selecting Credit Card terms you agree to pay by a provided card at time of shipment. If card fails for any reason, terms default to due immediately - paid by check or wire.

Applicant understands that ÖSSUR has the right to rescind open payment terms at any time. Application acknowledges and agrees that by electronically authorizing Össur to process this Credit Application, such authorization is legally binding in the same form and manner as a written signature.*

We certify that all the information on this form is true and correct. We fully understand and agree to pay in accordance to our selected standard Payment Terms and Payment Method provided under the Payment Terms section. We authorize ÖSSUR Americas, Inc. to contact any source necessary (including our bank, credit references and any credit bureaus) to complete an evaluation of our credit and financial history and hereby request that our bank and references release information requested about our account. Any changes made to this Credit application without Össur’s prior written consent shall be null and void.

In consideration of extension of credit and establishment of a credit account, applicant acknowledges liability for payment of amounts due ÖSSUR America’s Inc. If ÖSSUR America’s Inc. must take action to collect any balance owing, applicant agrees to pay all reasonable costs and expenses incurred in collection, including but not limited to collection fees, reasonable attorney fees, court costs and interest thereon at the then maximum legal rate. By signing this agreement, applicant acknowledges payment will be made on or before 30 days from the date of the invoice. By signing this agreement, applicant further acknowledges that the individual signing on its behalf is authorized to do so and that applicant will be bound by such signature. JURISDICTION AND DISPUTE RESOLUTION - Any action will be through a California court and California law will apply.By entering into this (Credit Agreement) I agree to be bound by the provisions of Össur Americas, Inc.'s Standard Terms and Conditions of Sale

8. Invoice/Statement Delivery Method: Group E-mail address preferred

Email address for billing:
E-mail address for online portal to view, pay and receive invoices:

Get receipt for application on same email as billing?

Customer Service
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  - How to Become an Össur Customer
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