Customer Account Registration

OSI Batteries completed the acquisition of Alpha Source batteries on 08/01/2024.
To order batteries, please visit https://www.osibatteries.com/alphasource.

Alpha Source Web Account Registration

We're happy you have chosen Alpha Source to be your source for medical products and supplies. Our easy account set up will get you on track to making fast, secure purchases of quality medical products. Having an Alpha Source web account will simplify the ordering process. Once your account is set up by our Customer Service department, you will be able to view order history, your special pricing, track shipping and more. Sign up now by filling out the simple form below!

Instructions:

To register for a customer account on the Alpha Source website, enter the requested information in the form below. Required fields are marked with an asterisk (*).

Contact Information:

Name: *

Company Name/DBA: *

Title:

E-mail: *

Phone: *

Fax:

Account Details:

Will you be making purchases for an organization that has ordered from Alpha Source in the past?
Yes No

Requested Payment Terms:

Credit Amount Requested:

Tax Status:
Taxable Exempt

As required by law, you must provide a tax exemption certificate. You can upload the certificate as either an image or PDF by clicking the button below. If you do not provide the certificate at this time, you will be contacted by Alpha Source to provide the certificate before you can place your first order.

DNB#

Do you distribute internationally?
Yes No

Accounts Payable Contact Info:

Name:

Phone:

Fax:

Email:

Electronic invoicing:

Would you like to receive invoices via email instead of mail? Yes No

If yes, enter email address to receive invoices:

Is this a GSA account?
Yes No

Is your organization a part of a Hospital Buying Group? Select one from this list:

Please list any supporting details (e.g. Premier - Entity Code:XXXXXX):

How did you hear about Alpha Source?

Billing Address:

Company Website URL:

Address: *

City: *

State: *

Zip: *

Login Options:

Username (30 characters max): *

Password: *

Re-enter Password: *

Your password must contain:

8-15 characters

At least one letter

At least one number

At least one special character: !@$^-_'"{}[]<>,.*:;

Cannot contain these characters: %&#+=? or space