Online Order Registration 
For information on distribution opportunities, please e-mail us at distribution@minsurg.com or call at 727-466-4550.
New Sales Representative Information
If you are a new Sales Representative, please fill out the New Sales Representative Information form below with your contact information. This information will be used to ship all TruFUSE products and material to the appropriate location. You will need the Distributor Password before you can register.
 * Distributor Password:
Distributor Name:
 * Sales Rep Full Name:
* Email:
 * Cell Number:
Office Number:
Fax number:
 * Indicates required field

Shipping Information
If ordered items will need to be shipped to a location that is different than the main address of the Distributorship, please enter that shipping address below (i.e. Sales Rep's address).  On the Online Order form, you will have the opportunity to add additional Shipping Locations if needed. 
Shipping Address:
Shipping Address 2:
Shipping City:
Shipping State:
Shipping Zip Code: