Customer Registration

For security and identity verification purposes, we require that customers fill out this form in order to be able to complete the order.

If you do not fill out the form, or if the information submitted does not match your order information, the order will be cancelled and you will be blocked from placing additional orders.

What is the Order Number you were given upon checking out.
Your Legal Name (First and Last) - must match order name.
Where will we ship your order.
We will call you to verify identity.
An email we can reach you at.
Click or drag a file to this area to upload.
Please upload images of your Driver's License, Passport, and/or a Government Issued Identification. Then name and address on the ID must match the name and address of your order.
Click or drag files to this area to upload. You can upload up to 3 files.
Include at least 1 picture of your face. Also include pictures of the affected skin area if not on your face.
By Signing this form, you verify that all your information is correct. If your information does not match the order info, we will cancel your order and disable your ability to place future orders