Diamatrix.com User Registration FormPlease enable JavaScript in your browser to complete this form. - Step 1 of 4Username *Password *Your Name *FirstLastYour 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 statusNo, thank you. Next Please tell us about you!Are you a *Surgeon, RN or Administrator looking for informationDiamatrix Customer (Domestic-USA)Diamatrix Customer (International)Diamatrix Domestic Sales RepInternational DistribuitorNextCustomer Account InformationBilling Phone Please provide a direct line to your Accounts Payable ContactBilling EmailPlease provide an email address so we can send your invoice to the correct person.Account Mailing Address / Billing AddressBill 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 2Address Line 2: (Suite, Unit, Building, Floor,etc.)Billing City *CityBilling State *State/ Province/RegionBilling Postal *Zip/Postal CodeAre you ordering on behalf of a physician *YesNoAre the mailing and shipping address the same?YesNoPreviousNextAccount Shipping Address (if not the same as mailing/billing)Shipping NameShipping Name: (Hospital, ASC, etc)Shipping Address 1Address Line 1: (Street Address, P.O. Box)Shipping Address 2Address 2 (Apartment, suite, unit, building, floor, etc.)Shipping CityCityShipping StateState / Province / RegionShipping PostalZip/Postal CodePreviousNameSubmit