Customer Information Form

Our platform is designed to kickstart the order process, making it easy for healthcare providers, pharmacies, and distributors get set up to access the products they need.

Want to become a new Ship-To-Site?

Complete the Customer Information Form

You can complete our Customer Information Form to initiate the process. This form helps us gather essential information about your facility and requirements. If you're a new account, please make sure to complete and submit the Customer Information Form. By doing so, you provide us with the necessary details to create a new Ship-To-Site for your facility.

You can also reach out to us via our dedicated line at 888-765-4747, Opt. 3. Our customer specialist team is here to assist you in the process.

Once you submit the form, our Customer Operations Specialists will review the information. If there are any additional details we require, our dedicated specialist will reach out to you directly. Our goal is to ensure a smooth process every step of the way.

New to our platform?

If you are a new account, please complete and submit the form below.

CUSTOMER INFORMATION FORM