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EarQ Membership Application

* denotes a required field

Please list your 3 preferred manufacturers:

Select all accounts you plan to transfer: *

If not all accounts, why?

Terms of Membership

New members agree to purchase at least 50% of their hearing aids from EarQ.

Save and Continue

Save your progress & continue with the transfer forms below. Nothing will be submitted to EarQ until you click "Submit Completed Application" at the very bottom of this page.

Oticon Logo
Account Transfer & Authorization
You have opted not to transfer/open an Oticon account at this time.
Signia Logo
Account Transfer & Authorization
You have opted not to transfer/open a Signia account at this time.
ReSound Logo
Account Transfer & Authorization
You have opted not to transfer/open a ReSound account at this time.
Starkey Logo
Account Transfer & Authorization
You have opted not to transfer/open a Starkey account at this time.
Widex Logo
Account Transfer & Authorization
You have opted not to transfer/open a Widex account at this time.
Sonic Logo
Account Transfer & Authorization
You have opted not to transfer/open a Sonic account at this time.
Submit Completed Application

By clicking submit you are submitting this form in its entirety to EarQ for review and processing.




EarQ   •   701 Erie Boulevard West, Syracuse, NY 13204   •   866-432-7500   •   Fax 315-487-7153   •   earq.com

© 2021 The Qgroup, LLC

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