Doctor Drop-Ship Account Registration

Online Drop-Ship Account Registration For Doctors
  • Contact Info

  • Enter a username. (Min. 8 alphanumeric, lowercase chars. only).
  • Enter a password for your online account. (Min. 8 chars., incl. uppercase, lowercase, numbers).
    Strength indicator
  • Account Payment Method

  • Select a payment method for your account.
  • For payment terms, download Credit Application*, fill and submit below.
  • Education

  • Enter your educational institution.
  • Communication

  • This field is for validation purposes and should be left unchanged.