Purchasing Application for SafeCareRX®

Use this application form to apply for a professional wholesale account to purchase the SafeCareRX® line form Scientific Bio-Logics, Inc. Information you provide here will be processed internally. An account application will be accepted if; you have a valid state reseller s license; and if your business is relational to the nutritional supplement trade/Health and wellness industry. Submitted data passed will be encrypted, with secure authentication access. You may edit submitted data any time with your login, once an account is established for you.

You did not fill out one or more requiered fields in this form!
Application
Prefix
First Name*
Last Name*
Suffix



(This will be your username upon approval)



 Healthcare Practitioner
 Natural Product Retailer
 Health Product Distributor