International Dealer Application

Thank you for your interest in being an international dealer with American Scientific, LLC. Please take a moment and fill out the form below. Once completed, your form will be reviewed by one of our AmSci representatives if more information is needed we will contact you. AmSci reviews many dealer applications, please expect a response within 3-5 business days.







  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY




  • NOTE: Accounts that have been inactive for longer than 2 years are required to complete a new dealer application.
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