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Register Account

If you already have an account with us, please login at the login page. If you do not know some details, you can leave them blank and update your account information later through the My Account links in the header and footer. All new customers are required to fill out a New Customer Questionnaire (PDF File) and submit it to us. We will not be able to send certain drugs until you have provided the appropriate DEA and/or state certificate numbers and uploaded a copy of your certificates. Both the New Customer Questionnaire and all DEA and State Certificates can be uploaded to CritiKit at the link below, or after you have created your account you can click on the "my account" tab on the top over every page to access the "document uploads" section.


Your Personal and Clinic Details








* First Name:
* Last Name:
CritiKit (or Banyan) Account #:
DEA Certificate Number:
Practice Speciality:
State Drug Certificate Number:
State which Issued Certificate:
Tax Exempt? (Yes/No):
Tax ID number:
* E-Mail:
* Telephone:
Fax:

Your Address

Company:
* Address 1:
Address 2:
* City:
* Zip Code:
* Country:
* Region / State:

Your Password

* Password:
* Password Confirm:

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File Upload

Certain medications must be shipped to the address your office has registered with the DEA. To process these orders we must have a matching DEA Certificate on file. Please upload a scanned copy of your office's DEA Certificate, as well as any certificate issued by your state. If you do not have your documents currently available, you can register without uploading the documents, and upload them later by selecting the "My Account" link in the header or footer on any page of the site. We will not ship items requiring a certificate on file unless you have uploaded the appropriate certificate.

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