New Customer Application Form

Become a Wholesale Customer with Innologic to purchase our products direct from our website.

To apply for an account, enter your details below to apply. You must have a registered ABN to apply.

Once we have received your application, please allow 5-7 business days for our Accounts team to process your request and verify your business. Once your account is open, we will send you an email advising you of your account details.

If you are outside Australia or Australia, please contact us for International Sales.

Business Details

Business Billing Details

Business Delivery Details

Doctor / Specialists

Login Details

This field is for validation purposes and should be left unchanged.