Provider Research Account Application | Premier Bio Labs

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Provider Research Account Application

Apply for institutional research pricing and dedicated technical support for laboratory peptide research. All products strictly for in-vitro use only.

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Institutional Pricing

Volume-based discounts

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Priority Fulfillment

Same-day shipping available

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Dedicated Support

Technical assistance team

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Complete Documentation

COAs & batch testing

Provider Research Application

Complete the application below to access research-grade peptides for laboratory use. Our compliance team will review your credentials and contact you within 1-2 business days.

⚠️ Required Compliance Documentation

Before proceeding, please ensure you can provide:

Professional License: Valid medical license, DEA registration, or institutional research credentials
Research Attestation: Signed confirmation that all peptides are for laboratory research only
Institutional Affiliation: Documentation proving legitimate medical practice or research facility
Non-Clinical Use Acknowledgment: Understanding products are NOT for human administration

Personal & Professional Information

First Name *

Last Name *

Email Address * Professional or institutional email preferred

Phone Number *

Professional Credentials/Title *

Medical Specialty/Field *

Medical License Number (If applicable) Required for physicians and licensed practitioners

License State (If applicable)

NPI Number (If applicable) National Provider Identifier for healthcare providers

DEA Number (If applicable) Drug Enforcement Administration registration

Practice/Institution Information

Practice/Institution Name *

Practice/Facility Type *

Practice Tax ID / EIN *

Practice Website (Optional)

Practice Street Address *

City *

State *

ZIP Code *

Country *

Research Use Information

Intended Research Purpose * Be specific about in-vitro research applications, studies, or laboratory protocols

Laboratory Capabilities * Confirm you have proper facilities for handling and storing research compounds

Expected Order Frequency *

Estimated Monthly Volume *

Professional Credential Verification

Upload Professional Credentials * Required: Medical license, DEA certificate, NPI verification, institutional credentials, or other professional documentation. Accepted formats: PDF, JPG, PNG (Max 10MB per file)

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Click to upload or drag and drop

PDF, JPG, or PNG (Max 10MB per file)

⚠️ REQUIRED: Research Use Only Attestations

You must read and agree to ALL of the following attestations to proceed with this application. These attestations are legally binding and ensure compliance with federal regulations.

I attest that all peptides purchased from Premier Bio Labs will be used STRICTLY for in-vitro laboratory research purposes only and will NOT be administered to humans or animals for any therapeutic, diagnostic, or clinical purpose. *

I acknowledge that these peptides are NOT FDA-approved drugs and are research chemicals only. They are not intended for human consumption, compounding into medications, or any clinical/therapeutic application. *

I certify that I have proper laboratory facilities and capabilities to handle, store, and conduct research with these compounds in accordance with applicable safety and regulatory standards. *

I understand that misrepresenting the intended use of these research peptides, or using them for human consumption or clinical purposes, may result in immediate account termination and potential legal consequences. *

I agree to maintain proper documentation of all research uses and to provide such documentation to Premier Bio Labs upon request for compliance verification purposes. *

I have read and agree to Premier Bio Labs' Terms & Conditions, Research Use Policy, and Compliance Guidelines. I understand that violation of these policies may result in account suspension or termination. *

Our compliance team will review your application and credentials within 1-2 business days

Questions about the application process?

Our provider relations team is here to assist with credential verification and compliance requirements.

providers@premierbiolabs.com or (307) 370-2330