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CREDIT APPLICATION FOR NEW BUSINESS ACCOUNT


To apply for a new account online please complete the form below and press SUBMIT button.

You may also download the form in PDF format, print it out,  fill and fax to  (888) - 519 - 2295

or send it to   Sales@osnovation.com

CLICK HERE to download PDF file.

ONLINE CREDIT APPLICATION FORM
(Required form fields are marked with  * )
    BUSINESS CONTACT INFORMATION


    BUSINESS AND CREDIT INFORMATION


    BUSINESS/TRADE REFERENCES
    1.
    2.
    3.

    AGREEMENT:

    1. All invoices are to be paid 30 days from the date of the invoice. 1.5% per month
    thereafter.


    2. Claims arising from invoices must be made within 7 (seven) working days.


    3. By submitting this application, you authorize OSNovative Systems, Inc. to make inquiries
    into the banking and business/trade references that you have supplied.

SUBMIT
HEALTHCARE PROFESSIONALS ONLY
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HOME
NON-HEALING WOUNDS
HEAVILY DRAINING WOUNDS​
PRESSURE ULCERS
DIABETIC WOUNDS


CLINICAL EVIDENCE
TESTIMONIALS
HOW TO PURCHASE
IF YOU HAVE A PRESCRIPTION
​CUSTOMER SUPPORT
HOW TO USE
FAQ
ABOUT US
MEDICARE REIMBURSEMENT CODES
HCPCS A6196 for  4”x4”
HCPCS A6197 for  6”x6”
Under the trade name: 
Enluxtra Wound Dressing
Covered for exuding wounds, up to 30 dressings per month.
500 Laurelwood Rd., Ste 1
Santa Clara, CA 95054
Phone: 888-519-2297
          
Email:  contact@osnovative.com 
© 2022 OSNovative Systems. All rights reserved. Disclaimer: The contents of this site is for reference purposes only and is not intended to substitute for advice given by a physician, pharmacist, or other licensed healthcare professional. You should not use this information for self-diagnosis or for treating a health problem or disease. Contact your healthcare provider immediately if you suspect that you have a medical problem.