Customer Registration - MD Supply Plus

Please note that only licensed medical practitioners can purchase products on MD Supply Plus. After creating an account below, you are welcome to place an order, but it will not be processed until your information is confirmed.

Your account will be verified within one business day. We’ll notify you and answer any questions you may have, and make sure you have a positive, rewarding experience.

Username *

Password *

Email *

Confirm Password *

Address *

Town/City *

Postcode/Zip *

State / County *

Country *

Phone Number *

Fax Number

Cell Number

How Did Your Hear About Us? *

Company Name

First Name *

Last Name *

Profession *

Medical License Number *

Additional Contact Name

Medical Specialty

License Expiry Date *

Please read our Terms of Use and Customer Agreement before creating your account.

Acknowledgment *

I acknowledge the information above to be true, and have read & accepted the the conditions outlined above in our customer agreement and terms & conditions.

MD Supply Plus

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