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Membership Application Form

 

Ready to take advantage of the savings options available to you by partnering with VGM Advantage? We're ready to help you grow your business while saving you money, all you have to do is fill out the application on this page. Simply select the type of business you're in and fill out the rest of the remaining fields to submit your application. You can also complete and print out PDF version of our application. We will review your application and contact you using the information you have provided.

  • Institutional Information:

  • Type of Business:
  • Membership Form Business Name
  • Purchasing/Contract Information:

  • Do you currently belong to any GPO?
  • Do you currently use any type of equipment financing?
  • Credentialing:


Check the appropriate credential/licensures for your organization.

(Copies of certificates will be requested upon submission.)

  • Medicare Provider?
  • Medicaid Provider?
  • Do you carry liability insurance?
  • Select Insurance Liability Type
    (Include copy of proof of insurance.)
  • State Licensed?
  • Services:

    Check the appropriate services for your organization.

I wish to be a member of VGM Advantage.
You warrant the information on or relating to this application is accurate, true and complete, and you will notify us of any material change to such information. We comply with Section 326 of the USA Patriot Act, which mandates that we verify certain information about you while processing your account application. You hereby authorize any bank, financial institution or trade reference listed herein to release usual and customary business or personal credit information to VGM. You also authorize us to offset any sums due from any of our affiliated companies, including but not limited to HOMELINK®, against any unpaid sums you owe us, our affiliated companies, without notice. You hereby waive any and all claims for payment of any offset made and also release HOMELINK from any and all claims or liability for said payment. You understand that we enter into contracts with certain vendors to obtain discounted pricing for VGM members, and that such vendors may pay a fee to VGM of up to three percent of the price of goods you purchase from the vendor. A copy of this signed authorization shall be deemed an original for all purposes. VGM reserves the right to refuse any applicant.

For a limited time, VGM Advantage Membership is FREE.
The $75 monthly membership dues are waived

Upon application receipt, a VGM Advantage representative will contact you to complete Part Two of our application process - The Group Purchasing Contract.

Please email the following documents to Info@VGMAdvantage.com

  • List of locations- including address, phone/fax, email, and contact person
  • Proof of Insurance
  • Any credentialing documents
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