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We Would Like To Welcome Your Company To HandiExchange

It all starts with building your company's profile. This form is for use by U.S. and Canadian companies of the following types ONLY:
  1. HME or DME Dealers
2. Adaptive Vehicle Dealers		   4. Medical Supply Dealers
5. Pharmacies		   6. Adaptive Sporting Goods Dealers.
7. Home Healthcare Providers
  3. Real Estate Agencies (Handling Barrier-Free Housing)
* If your company type is not listed above and you believe it should be, please let us hear from you, we'll look into adding it.

Adding your company's free directory listing takes 4 simple steps and only about 4 minutes to complete.

1. Complete the form below to set up your profile.
 
2. Activate Your Profile - IMPORTANT: Check your e-mail after submitting the form below and click on the validation link in the e-mail you received from HandiExchange.com, this will activate your account.
 
3. Login, using the Login to the right of the page tabs to add your free directory listing.
 
4. Under the heading "Add Directory Listing:" you will find a link to add a directory listing for your company type. Click the link. Complete and submit the directory listing form. Your in the directory.


Please make sure that the information you provide on this form is complete and accurate. If it is not, those viewing your directory listing may not be able to find you. Should you have any questions or problems please feel free to contact our customer service staff.

All form fields are required.
Company: 
First Name:       Last Name: 
Address: 
City: 
State:     
Zip Code: 

Phone: 

Email Address: 
Re-enter Email: 

How does your company do business:
E-Commerce Only    We have retail locations       Number retail locations:

Which of the following best describes your type of business? (check only ONE)
HME or DME Dealer
Pharmacy/Independent Drug Store
Home Health Care Provider
Rehab clinic/hospital/private practice physical/occupational therapy
Adaptive Sporting Goods Dealer
Medical Supply Dealer
Real Estate Agency Offering Barrier-free Housing
Scooter - Electric Wheelchair Dealer
Accessible Vehicle Dealer

Your Company Web Address:  http://

Has your company ever advertised with display advertising on HandiExchange.com in the past:
No   Yes

Check this box if you would like to be contacted about display advertising.   Contact Us

Choose the Username and Password you would like and enter them below.
Username:   
Password:   
Re-enter Password: