Practitioner Application

Click on the below link for the PDF version of our Wholesale application. This document can be downloaded and filled in using Adobe. The application needs to be completely filled out and returned with the required documentation or your application will be declined. Please allow up to 5 business days for processing.

Return your completed application and documentation to:

email: info@biopureus.com
fax: 855.317.1122

 

Wholesale Application 2019