Thank you for your interest in placing an order with us. In order to place an order, you must practice in one of the states we are licensed to sell in.
Before placing an order, you will need to create an account. There are some things you need to create an account and be eligible to place an order. Along with basic company and contact information, below is a list of items you will need to create an account:
- Name(s) of who is authorized to place an order or discuss account details
- Credit Card Authorization Form
- Copy of State Medical License Number & Expiration*
- Copy of Physician/Practitioner DEA Number & Expiration*
- Copy of Business/Facility DEA Number & Expiration*
*Must be current and unexpired
Please download the following two documents and follow the directions to submit them.
Once we have approved your account, you will be able to submit order forms online, or by fax or email:
Having an issue with creating an account? Let’s talk. We are happy to help with setting up your account. Please call us at (205) 995-0505.
Create an online account. After you have your documents ready, you can create an online account.