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Wholesale Inquiry Form

Complete this form to begin the qualification process for wholesale access to research peptides.

Contact Information

First Name *

Last Name *

Email Address *

Phone Number *

Organization Information

Organization/Company Name *

Organization Type *

Organization Website

Business Address *

City *

State/Province *

ZIP/Postal Code *

Country *

Professional Credentials

Professional License Number (if applicable)

Medical license, DEA number, or other professional credential

License State/Jurisdiction

Relevant Credentials/Certifications

Additional Information

How did you hear about us?

Additional Comments or Questions

⚖️ Research Use Compliance

All products are sold strictly for research and laboratory use only
Products are not intended to diagnose, treat, cure, or prevent any disease
Access is limited to qualified professionals and organizations
Proper documentation and credentials may be required for verification

I acknowledge and agree that I understand these products are for research use only, and I confirm that my organization meets the qualification requirements for wholesale access. I certify that all information provided is accurate and complete. *