1-800-522-4636
Home  |  About Us
 1-800-522-4636

Customer Support | New Account | Complete New Account Form

Complete New Account Form

New to Specialty Appliances?

Please complete the New Account form so that we can create an account for your practice! Upon receiving this document, we will contact you to introduce ourselves and get any additional information that we may need. Please make sure to provide contact information for whomever would be best to answer new account related questions should we have them!

*
  Required fields


General Information

  *

  *

  *

  *

  *

  *

  *

  *

  *

  *




Office Contacts

  *

  *

  *

  *

  *

  *


Shipping Addresses

(If different from the Practice Address entered above)


















Additional Info

How will you be submitting cases?

 
 
If submitting cases using digital scanners, please check which scanners:

 
 
 
 
 
 
Specific Interests:

 
 
 
 
 
 
 
 
 


List any doctors submitting RXs from this location and billing to this account.














(Include starting and ending times for each day.)


Billing Information

  *

  *





Receive statements via:

 
 
 
 

Payment Policy

We invoice each case as we ship it during the month. On the first of the following month statements are generated and mailed out; arriving in your office no later than the 6th or 7th. Our payment terms are Net 10 Days from the receipt of the statement, with the entire balance being due. Please pay by statement. All accounts not paid in full within 30 days of receipt of the month-end statement are considered Past Due. Any account that reaches 60 days Past Due is put on hold which prevents all cases from going to fabrication until the account balance is brought current. If an account reaches 90 days Past Due it is sent to collections with collection fees being added to the account balance.

We offer the following payment options for your convenience:

  • Automatic Credit Card Payment- Processed on the 1st business day of every month
  • Credit Card Payment- We accept MasterCard, Visa and American Express by phone or on-line through the customer portal.
  • Payment by Check - Please make check payable to Specialty Appliances and mail it to our lockbox:

Specialty Appliances
P.O. Box 406824
Atlanta, GA 30384-68
24

All other correspondence should be sent to our physical address: 4905 Hammond Industrial Drive, Ste J. Cumming, GA 30041.

Thank you for your attention regarding our policy. We look forward to your continued business. Please contact us if you have any questions.

  *

 




 
Answering the question above will help us reduce spam submissions. If your answer is incorrect, you will be able to try again.


1-800-522-4636
Email Customer Support

4905 Hammond Industrial Drive
Suite J
Cumming, Georgia 30041

Phone: 678-513-4408
Toll Free: 1-800-522-4636
Fax: 678-513-7345

Site Map  |  Privacy Policy
Copyright 2019, Specialty Appliances. All rights reserved.
Website Created By Edge 4
© 2019 Specialty Appliances
Website By Edge 4