Become a Vendor

Apply to sell products through ConnectHealthMD. We review every vendor application before approval.

* required fields

Personal Contact Information

This person will be the primary point of contact and this same email will become the future login email after approval.

First name* Last name*

Position / Title Phone*

Email*

Address line 1*

Address line 2 / Suite / Unit

Country* City*

State*

ZIP Code*

Business Information

Public company name* Legal business name*

Business type* EIN or business license number*

Sales tax ID Website

Years in business Average handling time (days)*

Support email* Support phone*

Product categories

About your business / What you sell

Return policy*

Business Address

Address line 1*

Address line 2 / Suite / Unit

Country* City*

State*

ZIP Code*

Shipping Origin Address

Address line 1*

Address line 2 / Suite / Unit

Country* City*

State*

ZIP Code*

Documents

Upload any compliance or onboarding documents that help speed review.

W-9 Business license Insurance COI Other documents

Confirmation

I agree to the Vendor Terms and Conditions and Privacy Policy.*

We respect your privacy — submitted application data is handled securely.