Create My Account

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Note: If you have placed an order with Clint Pharmaceuticals before, you already have a registered account in our online system.

Click here to email us or call us at 800-677-5022 to obtain your Log-In and Password information.

4 Easy Setup Steps

Create an online account to place web orders, or call 800-677-5022 (Initial order by credit card only, then terms are available on subsequent orders)
Download and complete the attached Customer Application
Send photocopy of DEA certificate (and Medical license for Idaho customers) by e-mail: customercare@clintpharmaceuticals.com or by fax 800-341-6440
When placing your initial online order, please note that the order will NOT be processed until steps 2 and 3 have been completed. For questions, please call Customer Care at 800-677-5022

Ship To: same as billing

Business Name:

First Name:

Last Name:

Professional Title:

Email Address:

Phone Number:

Fax Number:

Address:

Address 2:

City:

State:

Zip Code: