Please complete this form to apply as a PN Medical partner. Call 321-392-4608  if you have any questions. Thanks.

Reseller Application

Step 1 of 3

  • Select reseller if you are intending to purchase a PN Medical product for resale. Select affiliate if you are intending to promote the product, with purchasers buying directly from PN Medical. Select both if you are interested in both a reseller and an affiliate relationship
  • List all applicable company names (d/b/a's) that will be used to sell The Breather and if applicable Breather FIT. (ONE name per line - exact spelling required) Thank you!
  • Include http:// before URL