• Listing on the K-PAX web page as an authorized retailer.
• Complimentary counter stand, brochures, and window poster.
• Free Shipping with orders over $1000.00.
• Product samples to active retailers.

Before completing the Distributor Application below, please read the following important policies:

• Only K-PAX Immune Support products are available to retailers.
• Our products are not available through Pharmaceutical Wholesalers.
• All K-PAX retailers must possess a tax identification number or business identification number for resale purposes

1. Fill out the Distributor Application form below.

2. Upon review of your on-line application, you will be contacted and sent a Distributor Agreement and wholesale price list to review.

Distributor Application * required

E-Mail Address:*  Retype E-Mail:*  Password:*  Retype Password:*  Address:*  City:*  State:*  SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip/Postal Code:*  Date:*  Fist Name:*  Last Name:*  Title:*  Store Name:  Store URL:  Day Telephone:*  How did you hear about K-PAX?  Choose...Received a prescriptionMedical professionalCustomerOther What is your business type? Choose...PharmacyHIV Specialty PharmacyHealth Food/Vitamin StoreNon-Profit OrganizationOther What products (s) are you interested in ordering?  Choose...KPAX Protein Blend PowderKPAX Immune Support Formula CapsulesBoth Do you have a customer with a current Prescription for K-PAX? Choose...YesNo If you are not a pharmacy, please tell us about your organization.