About Us
Contact
Instructions
To become a customer please complete this application form and verify your details are correct.
This form is for new customer only.
If you already trade with us then please contact our customer service team on
+64 21 068 1122
to obtain a site email & password linked to your existing account.
Sign-up is subject to company terms & conditions.
Government information
Medsafe New Zealand
Product Application Search
Email *
Password *
Confirm Password *
Trading Name *
Registered Name *
Director / Partner Details / Pharmacy Owner
Title
First Name *
Last Name *
Position
Phone
Mobile *
Fax
Ship To Address
(A physical street address is required for delivery, no PO Box address accepted)
Attention To (on label)
Street 1 *
Street 2
Suburb
Postcode *
Country *
State
Bill To Address
Use Shipping Address above
Attention To (on label)
Street 1
Street 2
Suburb
Postcode
Country
State
Would you like to join our mailing list?
How did you find us?
Please Select
Referral
Online
Friend
Magazine Ad
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TV Commercial
Other
I agree to the
Terms and Conditions
of ZlandPharma Ltd. *
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