Organization / New Account Interest Welcome. Please fill out the form below, and Scrub Shop Inc, dba AC Uniforms & More will be in touch with you soon. You may expect to receive a response within 72 hours Monday through Friday. We look forward to hearing from you! Required fields marked * Name* Title E-mail* Phone Number* Facility / Company Name* Facility / Company Address* Facility / Company City* Facility / Company State/Province* Facility / Company Zip Code* Company Type* -- Select Hospital Medical Office Medical School Nursing Home Nursing School Other–Non-Medical Number of Employees* Payroll Deduction Available* -- Select Yes No ASI / Wholesale(Does Not Apply) Service of Interest* -- Select AC Uniforms Online Store Color Code Facility Scrub Fair Special Pricing for Groups Other Are You a Previous Customer?* -- Select Yes No Unsure Submit