New Customer Information Form

  • Primary Contact Information

  • Shipping Information

  • Shipping Method & Account

  • Terms

  • 1. I acknowledge that I have read, understand, and will abide by the terms and conditions listed at

    2. Completion of this form is not a guarantee of credit. A separate Credit Application must be submitted to establish a credit account.

    3. By submitting this form, you authorize Paragon Genomics to set up a user account for you in our system.

  • Account Registration

    Choose YES only if you don't have an online user account yet. You can use the account to place orders online.