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  • Saturday - Monday - CLOSED

LICENSED MEDICAL PROVIDER PURCHASES

LICENSED MEDICAL PROVIDER PURCHASES

Online Ordering Enrollment

Organization Name:

NuPlasma’s online ordering website, (NuPlasma website link), will allow authorized representatives of your organization to enter blood product and supply orders online, and submit them electronically to NuPlasma. Online ordering does not limit you to only online ordering, you may continue to call in orders if desired, and as required in the attached Usage and Definitions.

Please fill out below and click “Submit” button at the bottom of the document or email the completed form to [email protected] will be notified when your organization has been set up and will receive a PowerPoint presentation for training purposes. Please allow up to 48 hours for processing.

At least one administrator needs to be created by NuPlasma for your organization. The administrator will be responsible for creating additional user accounts, and may also place orders. Indicate up to two administrators below for NuPlasma to create.

 
First Name:

Last Name:

Preferred logon User ID:

Phone Number:

Email (see note below):

 

Email Note: The email address will be used for communications regarding the online ordering system in addition to order confirmations. When an order is placed, a confirmation email will be sent to the email address associated with the account placing the order. A number of choices can be considered regarding user accounts and email addresses.

  • One general user account for your organization that is used by all staff.Confirmation emails will be sent to a general email account.
  • Individual user accounts, all using the same general email address (see Forgot Password note below).Confirmation emails will be sent to a general email account.
  • Individual user accounts,using unique email addresses. When order is placed only user placing order will receive confirmation email.
  • Combination of general user accounts and individual user accounts.
  • General email address may be an email distribution list.

Forgot Password Link Note:The ‘Forgot Password’ link will send an email tothe email address associated with the account. If individual user accounts are used with the same email address, keep in mind that the ‘Forgot Password’ link will send an email to the general account and will contain the individual user’s password.

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