Primary Registration Form
Language
Account Credentials
This will be your login credential. It should be of minimum 6 characters and can include letters (a-z), numbers (0-9), at (@), underscore (_), slashes (/,\), Apostrophe ('), and period (.).
Enter a Password for your AHA Supplier Portal account. (Requirements: 8 character minimum, 1 lower case letter, 1 upper case letter, 1 number, 1 special character)
Re-enter the Password entered above.
Company Information
Enter the Legal Name of your business.
Enter your business Website Address.
Select the Country where your business headquarters is located.
Enter the Physical Address where your business headquarters is located.
Enter Additional Address details. (i.e.: building, suite, floor, room, etc...)
Enter the City where your business headquarters is located.
Select the State/Province where your business headquarters is located.
Enter the Zip Code where your business headquarters is located.
Enter the Main Phone Number for your business headquarters. Enter numbers only without spaces or dashes.
Currently not used by the AHA, do not enter a value.
Feel free to enter your business Fax Number.
Select a primary AHA Region where your business is capable of providing products/services. Select only 1 region. Select "National Center" if you can serve AHA on a national scale, internationally or can serve AHA's National Center location in Dallas, TX.
Select a Category that most closely aligns with the product/service your business can provide to the AHA. Select only one category.
Enter the Duns & Bradstreet Number your business is registered under. Enter a "0" if your business does not have a D&B Number
Select the appropriate US or Foreign Tax ID designation your business is registered under and enter your registered US Federal Tax ID Number or Foreign (Non-US) Registration Number. Select and enter ONLY one designation and number.
Primary Contact Information
Enter the First Name of your business' Primary Point of Contact for the AHA
Enter the Last Name of your business' Primary Point of Contact for the AHA
Enter the Primary Point of Contact's Email Address.
Enter numbers only without spaces or dashes.
This field should default to the Region selected above.
This field should default to the Category selected above.
Select the Time Zone the Primary Point of Contact is located in.
Secondary Contact Information
First Name Last Name Company Email Contact Role

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