NRS Rescue Qualification

Please call us at 1.877.677.7370 with any questions.

After you register for an agency/organization account, your information will be reviewed by the NRS Rescue Department and you will be emailed with login information (if you qualify). Having an NRS Rescue account will give you the ability to view pricing and place orders online.

Agency/Organization Billing Information

Agency/Organization Name (required):
Billing Address (required):
Billing Address Line 2
Billing Address Line 3
City (required):
State/Province (required):
Other:
Zip or Postal Code (required):
Country (required):
Billing Phone (required):
Preferred Payment Method (required):
1. Prepaid / Credit Card
2. PO Payment Terms
3. Other
Payment Method (required):
Use this address for billing and shipping purposes

Agency/Organization Shipping Information

Shipping Name / Attention To (required):
Shipping Address (required):
Shipping Address Line 2
Shipping Address Line 3
City (required):
State/Province (required):
Other:
Zip or Postal Code (required):
Country (required):
Shipping Phone:

Contact Information

Name (required):
Email (required):
Phone (required):
Fax:
Is your agency/department tax exempt? (required)
1. No
2. Yes
Tax ID Number (required):
Anything else we need to know?

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