Dealer Inquiries / Become a New Dealer

NEW DEALERS – Are you interested in becoming an authorized iWALKFree dealer? Tell us about your business by completing the form below and an iWALKFree representative will get you on board in no time!

EXISTING DEALERS – Please complete the form below and tell us how we can help you! An iWALKFree representative will get back with you right away.

What country are you located in?*
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Other Countries
Please visit our International Dealer Inquiry page.

click on the link below

International Dealer Inquiries»
What can we help you with?*
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MOQ
• Minimum order quantity is 3 units
• Minimum order quantity is 6 units
USA - MOQ*
- The minimum order quantity for the iWALK3.0 Hands-Free Crutch is three units. Please check the box to acknowledge this requirement.
CANADA - MOQ*
- The minimum order quantity for the iWALK3.0 Hands-Free Crutch is six units. Please check the box to acknowledge this requirement.

Existing iWALK dealers can place an order by visiting our Dealer Ordering page below.

Dealer Ordering System»

New Dealers – please change your selection above to “Becoming a new dealer”. You may place your order after your application has been accepted.

Contact information
Company Name*
Name*
First Last
Email*
Enter Email Confirm Email
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone Number*
Are you an existing iWALKFree customer?
- YES
- NO
Other inquiries - What would you like to know?*
Please visit our Technical Support page for further assistance.

Technical Support»
Which best describes your business?*
- Medical Practice
- Medical Practice with DME retail
- Brick and mortar retail (B2C)
- Online retail (B2C)
- Distributor (B2B)
- Third party insurance administrator
- Other (please explain)*
Other - Describe your business*
How did you hear about iWALK crutch?*
- Trade show
- Online searches
- Customer request
- Saw someone using it
- Saw advertisement
- Other - please explain*
Other - How did you hear about iWALK crutch?*
Which best describes your physical retail operation?*
- DME/HME
- Pharmacy
- O&P
- Other - please explain*
Other - Describe your physical retail operation*
How many locations do you have?*
Are you a member of a group purchasing organization?*
- VGM
- Medgroup
- Not a member of a GPO
- Other – please explain*
* Other- describe group purchasing organization*
Please provide your VGM account number (if known)
Will you market to local physicians?*
- YES
- NO
Will you populate local physician's offices with our free marketing materials? (brochures, RX pads, etc.)*
- YES
- NO
Do you sell online?*
- Yes
- No
What is your online store address? (list as many as applicable, 1 per line)*
Do you sell on third party e-commerce platforms such as Amazon, E-Bay, Walmart, Overstock, Wayfair, etc.?*
- YES
- NO
**PLEASE NOTE - SALES ON ANY THIRD PARTY E-COMMERCE PLATFORMS IS PROHIBITED UNLESS SPECIAL PERMISSION IS GRANTED BY IWALKFREE, INC.***
- I acknowledge third party e-commerce restrictions
Would you like an iWALKFree representative to contact you regarding placing an order?*
- YES
- NO
Going forward, what is your preferred method for placing an order?*
- Have an iWALKFree representative call me
- Place an order online (requires existing account)
- Fill out order form
Contact person - (if different than above)
Is there anything else we can do for you?*
Would you like an iWALKFree representative to contact you regarding placing an order?*
- YES
- NO
Going forward, what is your preferred method for placing an order?*
- Have an iWALKFree representative call me
- Place an order online (requires existing account)
- Fill out order form
Would you like to receive free marketing materials? (select items desired)
- Trifold brochures
- iWALK2.0 RX pads
Quantity of Trifold brochures - 25 per pack - indicate number of packs desired
Quantity of iWALK crutch RX pads - 25 sheets per pad - indicate number of pads desired
Contact person (if different than above)
Is there anything else we can do for you?*
How did you hear about iWALK Crutch?*
- Trade show
- Online searches
- Patient request
- Patient was using it
- Advertisement
- Other - please explain*
How did you hear about iWALK - Other*
What best describes your practice? (select all that apply)*
- O&P
- Orthopedic
- Occupational Therapy
- Physical Therapy / Physiotherapy
- Podiatric
- Sports Medicine
- Other - please explain*
*Other - describe your practice:*
How many locations do you have?*
Do you want to dispense iWALK from your practice?*
- YES
- NO
Where do you refer your patients to purchase their iWALK Crutch?*
- Local medical device retailer
- Online
- iWALKFree (Manufacturer)
- We don't refer
Do you have specific local retailers you prefer to refer to?*
- YES
- NO
Where do you refer your patients to purchase online?*
- Manufacturer (iwalk-free.com)
- Amazon.com
- No specific website referred
- Other websites (please list below)
Would you refer to a local retailer if available?*
- YES
- NO
Would you like us to connect you with a local medical device retailer?*
- YES
- NO
Retailer 1:
Company Name Contact Person Phone Number
Retailer 2:
Company Name Contact Person Phone Number
Retailer 3:
Company Name Contact Person Phone Number
Would you like us to connect you with other local retailers?*
- YES
- NO
- Not Applicable
Would you like an iWALKFree representative to contact you regarding placing an order?*
- YES
- NO
Going forward, what is your preferred method for placing an order?
- Have an iWALKFree representative call me
- Place your order online (requires existing account)
- Fill out an order form
What is your preferred method for placing an order?
- Have an iWALKFree representative call me
- Place your order online (requires existing account)
- Fill out an order form
Would you like us to send you free marketing materials? (select all that are applicable)
- Trifold brochures
- RX Pads
Quantity of Trifold brochure packs requested (25 brochures per pack)*
Please enter a number from 1 to 10.
Quantity of RX Pads requested (25 sheets per pad)*
Please enter a number from 1 to 10.
Contact person (if different than above) Name, Phone, Email
What else can we do for you?*
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International Dealer Inquiry

To contact us regarding becoming an international dealer or distributor click here.

If you need immediate assistance, please give us a call at

562 653-4222

Monday to Friday 9:00 AM-4:00 PM PST

Dealer Inquiries / Become a New Dealer

Other Countries

Please visit our International Dealer Inquiry page.

click on the link below

International Dealer Inquiries»

MOQ

Dealer Ordering System»

Contact information

Technical Support»

International Dealer Inquiry

If you need immediate assistance, please give us a call at

562 653-4222