Please complete the form on this page to begin the registration process.

Before you get started!  You will need to have access to the below documents to upload with the registration request.

1. A copy of your active State Board License
2. A copy of your active DEA License if applicable
3. A completed credit application: Download Credit Application

Fields marked with an asterisk (*) are required. Upon completion of this form, a representative will contact you to complete your application.

Please contact customer service by calling 800 429 6967 or email customer.service@fagron.us with any questions.