Create a New Account
To open an account with Bellco Generics, select the form below that meets your needs.
Email the completed form to your sales representative or SalesAdmin@BellcoGenerics.com.
For assistance with your application, call 866-638-1464.
Below you can find the application type that your business requires. Fill it out completely then print and sign the form. Then scan and email the completed form back to us. We'll review the form and contact you shortly about your application details.
Credit Card or Wire Transfer Options
If you will pay via Credit Card or Wire Transfer please download, complete and return this form to begin your application process.
Apply for Credit up to $25,000
To apply for a credit line up to $25,000, download, complete and return this form via email to begin your application process. This form contains your credit application as well as the new customer application.
Apply for Credit greater than $25,000
To apply for a credit line greater than $25,000, download, complete and return this form via email to begin your application process. This form contains your credit application as well as the new customer application.