Join Now: Your Purchasing Power Awaits

Already an Amerinet Member?

Sign up with Health Resource Services (HRS) to expand your range of discounts by gaining access to regional and options contracts negotiated by HRS. These contracts are exclusive to HRS members and are added to the extensive list of Amerinet contracts already available to you. Fill out the Membership Form below to gain access to this enhanced program.

To get started, please call 800.842.6663 or fill out the membership form below and a representative will contact you.

Membership Form

Are you an existing Amerinet member?* Yes No
Amerinet Member No.


Facility Name*
DBA/AKA
Type of Organization/Practice* Health Care Group
Dental Practice
Veterinary Practice
Research Center

Do You Accept Medicare/Medicaid? Yes No

How many Dentists in your practice?

Address*
Address (cont.)
City*
State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip*


Main Phone* () -
Main Fax () -
URL


Contact Name*

Prefix:

Mr. Ms. Mrs. Dr. Prof.

First Name:

M.I.:

Last Name:

Suffix:

  jr., R.N., etc.

Contact Title*
Contact Phone* () -   ext.
Email*


Contact me by Email Phone


How did you hear about HRS? Internet Search
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