It’s easy to apply for HMI Buying Group membership! Just complete the
short application below, click ‘Next’ to select the suppliers you wish to
set up to bill through HMI, then click ‘Submit’ to send your information
to HMI for processing

Or, if you prefer, simply print your completed application and supplier
authorization for billing, and fax toll-free to 800.501.6858 or mail to:
3530 Manor Drive, Suite 6, Vicksburg, MS 39180.

If you need assistance or would like to join by phone, call Jackie Dotson,
HMI Member Services, at 800.569.0681.

All Fields Required Principal Owner’s Name   OD     MD     Optician Years in Practice Years at this Location Date of Birth - (mm/dd/yy) Practice Name “Bill to” Name E-Mail Address Office Phone Number (no dashes) Office Fax Number (optional) (no dashes) Type of Practice: Solo OD     Solo MD     Group OD     Group MD     Optician     MD/OD     Social Security # (no dashes) Federal Tax ID # (no dashes) Billing Address   Street City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY       Zip Code  Shipping Address (if different from above) Street City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code Owner's Home Address (required for credit verification) Street City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code Level of monthly credit you wish approved: $100-$999     $2,000-$3,999     $1,000-$1,999     $4,000+     How did you hear about us? Membership Agreement I have read and do consent to the membership agreement for HMI Buying Group as stated in the terms and conditions below. Please note: Whether your practice is solo, incorporated, a partnership or an association, all principal owners must sign below. First Name Middle Initial Last Name First Name Middle Initial Last Name HMI Buying Group Terms and Conditions of Membership This contract made and entered into by and between HMI Buying Group, Inc. hereinafter referred to as HMI, and the applicant corporation, association, partnership, or individual known as Member as signed below. HMI and Member agree to the terms and conditions of membership as follows: 1. HMI membership is open to eyecare professionals and/or owners of optical retail establishments. 2. Members to use their personal HMI drop-ship numbers to order directly from the manufacturer, with supplies to be shipped directly to the member's office, or assigned drop-ship locations. 3. HMI agrees to pay suppliers for any products ordered on an HMI drop-ship number by an HMI Member in good standing. 4. HMI will bill Member on or about the sixth (6) of each month following purchases. To obtain published discounts, full payment to HMI must be received by the 20th of the same month. Failure to meet the above payment agreement will result in loss of discount (minimum 5%). 5. Failure to use HMI for more than six consecutive months may result in termination of your membership in HMI without the necessity of notification. 6. HMI allows the return of any products for credit that are approved by the supplier and agrees to always issue Member's credit for returned merchandise the same billing period that the supplier issues credit to HMI. Member understands that partial payment to HMI in expectation of future credits will result in loss of that month's discount. HMI does not accept responsibility for unauthorized or improperly returned items. 7. Member agrees that should their account remain unpaid after the last day of the month that their billing is received, membership may be suspended/terminated and all rights and privileges under this agreement shall be null and void. Member specifically agrees to pay HMI for any and all supplies ordered during the period from date of last billing until their account is paid in full. In the event membership is suspended due to non-payment, all future, un-billed invoices will immediately become due and payable. 8. Member agrees that the extension of credit is at the sole discretion of HMI. Credit worthiness may, at any time, be subject to reverification. Adverse credit information will be grounds for immediate termination of membership without prior notice. 9. In the event it becomes necessary for HMI to refer this account to a collection agency or attorney for collection, Member agrees to pay all costs of collection including court costs and reasonable attorney's fees up to 50% of unpaid balance. Member agrees to submit to the jurisdiction and venue of the State of Mississippi and its laws and statutes should enforcement of any of the terms and conditions in this agreement become necessary. 10. HMI forwards names and practice address to business partners in order to establish member accounts. Business partners may use this information to inform members of special promotions and offers. HMI reserves the right to contact members via e-mail for promotions and offers for HMI related businesses. HMI will not share e-mail addresses with any business partners. 11. Member agrees that if they do business as a corporation, association, or partnership each member of said entity shall execute this agreement in his individual capacity and by such act shall individually guarantee payment of all charges billed by HMI and abide by the terms and conditions of this agreement. 12. In the event of transfer of ownership of practice or business, Member is required to send HMI written notification and the new owner must submit a new credit application. Member is liable for all charges incurred on his account until such notification is received. 13. Upon signing this application, I authorize HMI to obtain a written or oral report from any credit reporting agency and authorize my bank and trade references to give HMI any and all necessary information needed to process this application.   .