Are you interested in joining the Vac-H family?

We’re accepting dealership applications to expand the reach of our life-saving anti-choking technology.

Please complete the form below to submit your application. Your information will be used solely for the application process and handled with care. Thank you for your interest!

Applicant's Full Name *
Business Name *
Tax number *
Business Type *
Dealership Application City / Region *
Phone Number *
Address *
Email Address *
Area of Operation *
What is your motivation for becoming a Vac-H dealer? *
Notes *