Order NutriPlex: New Account Sign up

This form is for Healthcare Practitioners Only.
NutriPlex Formulas offers its product line directly through healthcare practitioners.

Patients/Non-Doctors — info about ordering here >

We contact every new account applicant to verify their identity. Please do not apply for an account unless you are a healthcare practitioner interested in offering our products to your patients through your current practice.

Fill out the form below to apply for a NutriPlex account:

    Your Email (required)

    Name of practice (required)

    Name of healthcare practitioner (required)

    Type of healthcare provider you are licensed as (required)

    Name of office manager or alternate contact

    Phone (required)

    Street address (required)

    City (required)

    State (required)

    Zipcode (required)

    Website

    How did you hear about us?

    Additional Information Required
    – We require a copy of your Business License. You may email a pdf to info@nutriplexformulas.com.

    – If you practice in Colorado, please email or fax a copy of your sales tax resale certificate.

    Confirmation
    We will confirm receipt of the above information by either telephone or email.

    You are considered to have only made an inquiry to our company until you place your first order. To open an account, a $300 wholesale order is required.

    Subsequent orders do not have purchase minimums, except to receive free shipping.