KLM Laboratories, Inc.

New Account Application

To open an account with KLM Labs, review and agree to KLM’s policies, terms and conditions as described below. Then complete the required account information on the following page. Please allow us 2-3 business days to review and respond to your application.

KLM warranties all custom foot orthotics as they are prescribed for 6 months. The standard warranty covers materials from breakage and defects in workmanship. The warranty does not cover changes to the prescription.

KLM cannot issue credit due to patient non-compliance, non-tolerance, non-acceptance, or reimbursement failures. Lab error or workmanship claims will be honored at full credit if declared within 90 days. Most fitting issues can be resolved with adjustments. Customers returning orthotics for adjustments should include detailed information describing the patient’s problem and special directions for the adjustment. Charges may apply for adjustments. Please contact KLM’s Customer Service Team for clarifications. KLM representatives can assist you by recommending adjustments that have been found effective in addressing certain orthotic compliance problems. KLM does not warranty adjustments made contrary to our experience or recommendations.

All initial supply, prefab and/or bulk OTC orders require credit card prepayment.

All KLM products are considered “made to order”. Order cancellation fees are as follows:

Before cast work 0%

After cast work, before shell forming 25%

After shell forming before posting 50%

After posting before assembly 75%

After assembly, before shipping 100%

After shipping 100%

By signing below I confirm that I have read the above policies and agree to the terms.

Print Full Name

Today’s Date

Doctor/Practitioner Name:

Title

Group/Company Name:

Ship to Address:

City:

State:

Zip:

Country

Years In Business:

Telephone #:

Fax #:

Email Address: *

* With KLM’s eLab you can write and track orders online, download KLM’s Digital Casting App for iPad, communicate with Customer Service via secure Support Tickets, schedule pickups, and so much more! *

Same Address for Billing and Shipping:

Yes
No (IF NO PLEASE LIST)

Bill to Name:

Responsible Party Name:

Billing Contact:

Address:

City:

State:

Zip:

Telephone #:

Fax #:

Send Invoices Attn:

Office Hours:

Send Invoices:

With Shipments
By Email

Purchase Order Required:

Credit Card #:

Exp Date:

Name on Card:

Auto Charge
Verify Charge

Federal Tax ID #:

Do you hold a resale certificate in your state?

Resale or Seller’s Permit #:

(IF YES, PLEASE INCLUDE COPY)

How did you discover KLM Labs?

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Thanks for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

All collections