Business customers only

Apply for a Business Account

Complete the application below. Requirements adjust automatically based on your type of business.

Contact Information

First Name *

Last Name *

Email *

Phone *

Business Information

Company / Organization Name *

Type of Business *

Country *

Legal Business / Practice Name *

Business / Practice Address *

City *

State *

ZIP *

Address verification requirement

The business or practice address submitted here should match the applicable NPI location/address.

Business / Facility Type 2 NPI Number *

Practice Type 2 NPI *

Ordering Physician Type 1 NPI *

EIN Number *

Your EIN is encrypted before storage and is visible only to authorized account reviewers.

Authorized Purchasing Contact *

State Pharmacy License Number *

Please describe your business *

This organization represents itself as Medicare-enrolled

Required Documents

Files are encrypted in transit and stored in private server storage. Accepted: PDF, JPG, or PNG, up to 8 MB each.

NPI Documentation *

Upload documentation supporting the NPI entered above.

IRS EIN Verification *

Upload IRS CP 575 / CP 575G or equivalent showing the EIN and legal business name.

Pharmacy License *

Upload the current state pharmacy license for this location.

W-9 *

Upload a current signed W-9.

Business License *

Upload the current business license.

Accreditation Certificate *

Upload the current DME accreditation certificate.

Physician License *

Upload current supporting physician license documentation.

Facility / ALF License *

Upload the current facility license.

Account Security

Password *

Confirm Password *

Use at least 10 characters. Your password is never emailed or stored in readable form.

I confirm that the submitted information and documents are accurate and that I am authorized to submit them.

Your account will remain pending until our team reviews the submitted business information and documentation.

Medical Accessories

Face Mask

Hospital Equipment

Temperature Gun

Business Account Application