Applications and Forms
Access most commonly used forms and applications.
Read instructions, complete, and review the checklist within each application to ensure corresponding documentation/applicable product sample is included with submission.
The below verification applications will be retired August 31, 2018.
The below verification applications/forms will be effective July 9, 2018.
The below attestations must be printed/submitted on company letterhead
- Manufacturer Name Change - Attestation regarding Manufacturer name change resulting from a corporate merger/purchase
- Model Number Addition - Attestation regarding addition of model numbers. Must print/submit on company letterhead. Submit product literature and effective begin date for new product(s)
- Private Label Agreement – Distributor Attestation - Attestation Regarding Addition of New Manufacturer/Distributor Name Resulting from Private Label Agreement – Distributor Attestation
- Private Label Agreement – Manufacturer Attestation - Attestation Regarding Addition of New Manufacturer/Distributor Name Resulting from Private Label Agreement – Manufacturer Attestation
- DME PDAC Contact - Submit an email to PDAC for answers to coding and product inquiries