Becoming a Retailer is easy! Just fill out the form below and someone from our customer service team will reach out to you with additional information.

Contact Name *
Contact Name
Service or Lab account *
Accounts can be both a Service account and a lab account! Please contact our customer service team if you have additional questions.
Main Phone *
Main Phone
Fax
Fax
Billing Address *
Billing Address
United States only
Shipping Address (if different from billing)
Shipping Address (if different from billing)
Account's Payable *
By default all eClips accounts start as "prepaid". Meaning orders are paid individually with a credit card. In order to transition to a monthly statement all accounts must complete and submit a credit application to our accounting department. Please select the best option for your office.