Become a Registered Supplier

	Once this information has been received by our Help Desk, your account will take up to two (2) business days to create. You will then receive an e-mail confirmation from info@medbuy.ca to reset your password. Follow the instructions indicated in the e-mail to login and activate your new Medbuy mSourcing Supplier account.

	First Name:*

	Last Name:*

	Title:*

	Organization Name:*

	What type of product(s) does your organization manufacture?*

Type of Organization:*
Please select the contracting program that best describes the kind of products offered by your company.

Medical/Surgical

Pharmacy

Both

Other, please specify

	Organization's Physical Address:*

	Physical Address 2:

	City:*

	Province:*

	Postal Code:*

	E-mail:* The e-mail address that you specify will be your mSourcing Supplier Username. We will use this e-mail address to send you RFx notifications and invitations.

	Website:

	Main Phone:*

	Direct Phone:

	Mobile Phone:

	Fax:

	DUNS Number:

	Please enter the Medbuy Contact (Medbuy staff member(s)) listed in the Biddingo RFP posting: This is to ensure your information is forwarded quickly to the appropriate department.

Done