Distributor Information

Distributors interested in more information on how to buy EPHED® or other DMD Pharmaceuticals® products. If you would like more information on creating attractive profit margins by adding this fine line of products, please fill out and submit the Distributor Request Form below, and a sales representative will contact you with the requested information.

Learn how you can begin allowing your Retailers to buy EPHED® and other DMD Pharmaceuticals® products from you.

Distributor Request Form

Distributor Name *
Address
City
State *
Zip
Phone Number *
(xxx-xxx-xxxx)
Fax * (xxx-xxx-xxxx)
Email Address *
Contact Person *
Title
Number of Stores Serviced
States Serviced
(hold down CTRL key to select more than one)
Retail locations serviced
(check all that apply)



Do you service any of the following
(check all that apply)

Energy Products distributor is selling
What prompted distributor to contact DMD?
Does distributor sell ephedrine/pseudo-ephedrine products?
Has this company been issued any DEA warnings?
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