Reset Supply

Provider signup

Create your Reset Supply provider account. Practice access is reviewed before ordering is enabled.

Already have a provider account?

Your application

Provider

First name Last name Suffix (optional)

Email Phone

Practice

Trade name / DBA (optional) Practice phone * Practice email (optional; defaults to account email) Primary contact title (optional)

Company or organization name Business type Website (optional) NPI number (if applicable) State license number (optional) Reseller permit number (if applicable)

Does the NPI owner match the account contact? Yes No Not applicable

Does the business have a reseller license? Yes No

AddressSuite / unit (optional) Address line 1

City State ZIP code

Verification

Professional title / credentials * Specialty (optional) License state (optional) License expiration (optional)

Professional credential type (optional) Referred by (optional)

I can provide proof of business, institutional status, or professional licensing if requested.

Reseller Certificate

Upload your completed certificate for qualifying resale purchases. Certificate acceptance and tax exemption require manual review.

Certificate state / jurisdiction (optional) Certificate expiration (optional)

Reseller Certificate file (optional)

PDF, PNG or JPEG, up to 10 MB. After creating your account, enter your account email and password above and choose Upload and save. Files are stored privately for your practice and Reset Supply reviewers.

Provider portal account

Password * Confirm password *

This creates your new provider portal account, separate from a Shopify shopping account. Your application details are saved securely with your account.

Additional notes Comments (optional)

I confirm that this application is for a legitimate business, laboratory, institutional, or qualified research purpose. I understand that Reset Supply products are for professional use only.

Submission does not guarantee approval. Reset Supply reviews every practice and resale certificate.

Provider signup

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