Medical Isotopes, Inc.

New Account Registration

Contact Information:

The contact information enables the Medical Isotopes staff to contact you in case there are questions concerning your order.

Email:

Password:

Password must be at least 8 characters.

First Name:

Last Name:

Company:

Department:

Address:

City:

State/Province:

Postal Code:

Country:

Phone:

Ext: Fax:

Billing Information: Same as Contact Information

The billing information is required to enable the Medical Isotopes staff to validate and/or complete the payment processing of your order.

First Name:

Last Name:

Company:

Department:

Address:

City:

State/Province:

Postal Code:

Country:

Email:

Phone:

Ext: Fax:

Shipping Address: Same as Contact Information

The shipping address provides Medical Isotopes with the delivery instructions needed to get your order delivered to any of your laboratory locations worldwide.

First Name:

Last Name:

Company:

Department:

Address:

City:

State/Province:

Postal Code:

Country:

Email:

Phone:

Ext: Fax: