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New Account Setup Form

Please provide your Employer Identification Number and NOT your Social Security Number.

If Credit Card, contact Boston Scientific Credit Dept. (please do not add CC info into this form) Call # 888-272-9442.

By signing above, you are attesting that you have the appropriate authority to execute this application on behalf of the applicant, and that the information herein is complete and accurate. Furthermore, you are hereby authorizing Boston Scientific to use all information you enter onto this form to process your application, carry out contract, support, payment and related activities, if applicable, and use this information for additional purposes identified in its Privacy Policy. You are also authorizing Boston Scientific to share information contained in this application with its subsidiaries, affiliates, successors and assigns. This application is subject to Boston Scientific’s credit policy, and Boston Scientific at its sole discretion may elect to refuse or to extend credit, or to limit the amount of credit extended.

This agreement and performance by the parties hereunder shall be construed in accordance with the laws of the state of Delaware, USA, without regard to provisions on the conflicts of laws and the parties’ consent to the exclusive jurisdiction of, and venue in, the State and federal courts of Massachusetts.

Boston Scientific reserves the right to charge interest on any amount not paid when due at the maximum rate permitted by applicable law.

The applicant agrees to reimburse Boston Scientific all fees and costs Boston Scientific incurs while seeking legal remedies to protect or enforce its rights under this agreement, including fees associated with collection of any past due payment and agency fees.