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Customer Application Form

New customer application

Open your Medical Supermarket account

Join the GP surgeries, care homes, pharmacies and clinics who buy their medical supplies from us. Fill in your details below and our team will set up your account.

With your account

Next-day delivery when you order by 4pm
Real people on the phone, 9am to 5pm
Free price comparison on your basket
Invoices emailed to your accounts team

Tell us about youTakes a couple of minutes.

We set you upOur team checks your details and creates your account.

Start orderingShop online, by phone or by email.

New Customer Application

* This information is required.

Company Name *

Contact Name *

Contact Email *

Contact Telephone *

Type of Company*

Address*

Post Code*

Registered Company Number

Email Address for Invoices*

How did you hear about us?*

Do you agree to our Privacy Policy & Terms & Conditions*

Would you like to receive emails about our latest offers and news?*

Click here to view our T&C's | Click here to view our Privacy Policy

Ordering medicines?Complete our POM authorisation formWe need this before we can deliver Prescription Only Medicines to your address. →

Rather apply over the phone?Our team will happily set you up, Monday to Friday, 9am to 5pm.Call 020 3301 6500 Email us