Durable Medical Equipment Supplier Application

The Durable Medical Equipment Affidavit (PDF) must be scanned and attached to your application.

Tips for attachments

You can attach a .jpg, .gif, .png, or .tif image file, or PDF file.

Maximum file size must be 4 MB or less. 1 MB = 1024 KB

When your application is approved, you can log in and print duplicate copies of your license to prominently display at each of your physical business locations.

Once your document is scanned and ready to attach, you can continue.