Registration

Username *

Password *

Your Name *

First

Last

Your E-mail *

Preferred customers receive montly coupons and sales notices from cs@diamatrix only! We do not share your email address with 3rd parties. You may unsubscribe at any time. *

Yes, I'd like preferred customer status
No, thank you.

Please tell us about you!

Are you a *

Surgeon, RN or Administrator looking for information
Diamatrix Customer (Domestic-USA)
Diamatrix Customer (International)
Diamatrix Domestic Sales Rep
International Distribuitor

Customer Account Information

Account Mailing Address / Billing Address

Bill To Company Name *

Account Name (Facility, Hospital, AP System, etc.)

Billing Address *

Address Line 1: (Street Address, P.O. Box, C/O)

Billing address line 2

Address Line 2: (Suite, Unit, Building, Floor,etc.)

Billing City *

City

Billing State *

State/ Province/Region

Billing Postal *

Zip/Postal Code

Are you ordering on behalf of a physician *

Yes
No

Are the mailing and shipping address the same?

Yes
No

Customer Account Information

Account Mailing Address / Billing Address

Account Shipping Address (if not the same as mailing/billing)