MedGuard Protection Plans

New Client Registration

Thank you for your interest in offering MedGuard Protection Plans to your customers.

Please provide the information below to get started. By submitting this form you agree that the information provided is accurate and that you agree to adhere to the MedGuard Distributor Agreement which can be found on the link below. A registration confirmation will be sent to you at the email address you provide. Please check your spam folder in the event that the confirmation email is not received.

Company Information

Company Name*

Are you representing a Company? Complete this field with your Company Name. Or, if you are doing business as an Individual, then leave this field blank.

Company Address 1*

Company Address 2

City*

State*

Zip*

Tax ID#

Website

Primary Contact Information

First Name*

Last Name*

Email*

Phone*

Additional Information

If you were contacted by one of our sales representatives, please enter their name.

By submitting this form and offering MedGuard Protection Plans to your customers, you acknowledge and agree to abide by the MedGuard Distributor Agreement.

New Client Registration Agreement