New customer contact form

By clicking the “Submit” button, I confirm that I have read, understood, and agree to the following terms:

• I represent that neither I, my employees, nor my affiliates (collectively, “Screened Individuals”) are presently debarred, suspended, ineligible or excluded from participation in any state or federal healthcare programs (collectively, an “Excluded Individual or Entity”). I will periodically check applicable federal and state databases for Excluded Individuals and Entities and notify ResMed if I discover that a Screened Individual has become an Excluded Individual or Entity. If a Screened Individual becomes an Excluded Individual or Entity, the Excluded Individual or Entity will stop providing services to ResMed. I understand ResMed does not do business with an Excluded Individual or Entity.
• I acknowledge that any information disclosed to me by ResMed, including but not limited to invoice terms and product pricing, is confidential and/or proprietary to ResMed. I further agree that, as consideration for ResMed’s disclosure of such confidential and/proprietary, I will not disclose, and will ensure my employees and affiliates do not disclose, such confidential and/or proprietary information to any third party without the prior express written consent of ResMed. I acknowledge and understand that any breach of this agreement may result in legal action, including but not limited to injunctive relief and damages.