New Account Signup

For Healthcare Practitioners Only

NutriPlex Formulas only offers its product line through healthcare practitioners and does not sell directly to the public. We contact every new account signup 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.

If you are NOT a practitioner, but are interested in taking NutriPlex Formulas supplements, please click here.

Please Fill out the form below to sign up for a NutriPlex Account and our Offices will be in touch with you shortly. Thank you.

1. Name of Practice(required)
2. Name of Healthcare Practitioner(required)
3. Type of Healthcare Provider you are licensed as:(required)
4. Street Address(required)
5. City/State/Zip(required)
6. Phone Number(required)
7. Email(valid email required)
8. Name of Office Manager/Alternative Contact
9. Comments or Questions?
10. Fax Number (optional)
11. Website (optional)

 

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Additional Information Required
• We require a copy of your Business License. You may email a pdf to info@nutriplexformulas.com, or fax it to: 303-449-7591

• 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. At that time, we will compile a ‘Welcome Kit’ to give you additional information. You are considered having made an inquiry to our company until you place your first order. To open an account, a $250 wholesale order is required. Orders after that do not have a minimum except to receive free shipping.