New customer registration form

Please complete the form on this page to begin the registration process. Fields marked with an asterisk (*) are required. Upon completion of this form, a representative will contact you to complete your application.

Prior to activating your account, we require you to provide the following:

• A copy of your active State Board License
• A copy of your active DEA License if applicable
• A completed credit application:
  Download Credit Application

You may submit the credit application using any of these methods:

• Email: customer.service@fagron.us
• Fax: 800-687-8902
• Mail: Attn: New Account Registration
  Fagron Inc.
  201 W. 5th Street, Suite 1250
  Austin, TX 78701

For more information, please email us at customer.service@fagron.us or call us at (800) 423 6967.