Eclipse Meds offers flexible payment options to suit a variety of needs.

New Customer Application

Please download, complete, and return the New Customer Application below. Send the application, along with copies of your pharmacy’s state license and DEA certificate to info@eclipsemeds.com in order to establish your account prior to placing your initial order.

(right click on the image below to download)

Eclipse-Meds-New-Customer-Application-Form-4