Merchant Registration

  • Attention Healthcare Provider.

    We provide bulk discounts to healthcare providers who are validated by our merchant ordering and authentication system. Please fill out the form below to set-up your merchant account.

  • Please upload your professional license, certification, and/or re-seller's license.*

    *Please note that we are required to collect sales tax on orders in Michigan for those without a re-seller's license. For those in Michigan please include your re-seller's license so that sales tax can be waived for wholesale orders.
    Drop files here or
    Accepted file types: pdf, jpg, png, jpeg.
  • This field is for validation purposes and should be left unchanged.