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New Customer Account Form

Facility Type (must check one):
Category:
Product Taxable:
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).
Upload Tax Exempt Certificate
Entity Taxable:
If no, provide your State Tax Exempt Number and Exempt Certificate.
Distributor Information
For Internal Use Only - CIT Ortho
Facility Information
Bill To:
*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.

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This information/document is confidential and proprietary. It may not be reproduced, used or disclosed to others without written consent of CIT Ortho.
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