To be listed as a resource provider and to offer our products:

Certified Puricorp Provider

To become a Certified Puricorp Provider please fill out the following form so we know that you are a legitimate Provider resource. On the next page you will be able to review the Practitioner Product Program financial information details prior to making your final decision about becoming a part of our Certified Provider Network. You will not be asked to order anything or to provide any credit card or bank information in this process, and you are not ever required to purchase product unless you wish to have product in stock for your clients.

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