Doctor Drop-Ship Account Registration Online Drop-Ship Account Registration For DoctorsContact InfoUsername*Enter a username. (Min. 8 alphanumeric, lowercase chars. only).Password*Enter a password for your online account. (Min. 8 chars., incl. uppercase, lowercase, numbers). Enter Password Confirm Password Strength indicator Name* Prefix Mr.Mrs.MissMs.Dr.Prof. First Last Facility/Business Name*Business Tax Id Number*Business Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Business Telephone*Mobile TelephoneEmail* Website Account Payment MethodPayment Method*Select a payment method for your account.Select ...Credit CardPayment TermsSubmit Credit ApplicationFor payment terms, download Credit Application, fill, save and submit (upload) below.Accepted file types: pdf, Max. file size: 128 MB.EducationEducational InstitutionEnter your educational institution.Select...Canadian College of Naturopathic MedicineBoucher Institute of Naturopathic MedicineOtherSpeciality*Select ...Family MedicineHolistic MedicineHomeopathyNaturopathic MedicineOriental MedicineOtherCertification*Select ...Naturopathic DoctorMedical DoctorOriental Medicine DoctorTherapistHealthcare StudentOtherLicense NumberCommunicationHow did you hear about us?Select ...AdvertisementColleague/Friend/FamilyConference/SeminarInternetPatient/CustomerSales RepresentativeOtherLatest News Send me the latest on products, promotions and general newsTerms of Use and Privacy Policy* I have read and agree to the Terms of Use* and Privacy Policy*.NameThis field is for validation purposes and should be left unchanged.
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