Profile details (Hearing Aid Professionals)

If you are a Hearing Aid Professional you can register here.  The fields marked with * are mandatory    

User account info

  
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Contact information

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One user can have multiple profiles. For example, you could have a profile for personal orders, another for office use and another for ordering for friends and family...

Billing address

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To ensure that a person, not an automated program, is filling this form, please enter the characters you see in this picture. All letters will be shown in their capitalized form.

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Characters: 

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