top of page
New Customer Account Form
Facility Type (must check one):
If Entity is taxable but Product is not Taxable, please provide a State Tax Exempt Form supporting Exempt Product (Please consult with your Internal Tax Department or Advisors).
If no, provide your State Tax Exempt Number and Exempt Certificate.
For Internal Use Only - CIT Ortho
*NOTE: IF HOSPITAL IS TAX EXEMPT, A COPY OF THE TAX EXEMPTION CERTIFICATE OR LETTER MUST BE FAXED TO CIT ORTHO. AN IRS 501c3 LETTER MAY NOT BE SUFFICIENT TO SUPPORT EXEMPTION.
Please make sure all fields are filled out, then try again
Thank you for filling the form! Your response will be filed shortly.
This information/document is confidential and proprietary. It may not be reproduced, used or disclosed to others without written consent of CIT Ortho.
bottom of page