Verified Practice and Vetsulin® Direct Registration

Please complete the form below to confirm your account credentials and finalize your Verified Practice status. This step ensures secure and compliant access to Merck Animal Health’s eShop and affirms your account’s eligibility to purchase Vetsulin® Direct, as well as other applicable benefits and services.

If you have any questions, please reach out to your Merck Animal Health account representative, our Customer Care team at customercareeshop@merck.com, or visit https://www.merck-animal-health-usa.com/ecommerce/contactus.

‘*’ Denotes required fields.

ACCOUNT DETAILS:

The information below has been pre-filled based on your account. Please take a moment to confirm that the details are correct.

account_1(Required)

account_address_1(Required)

account_address_2

account_city(Required)

account_state(Required)

account_zip(Required)

Phone(Required)

Vet of Record*

vet(Required)

Are the account details above correct?*

correct_info_account(Required)

Yes

If you selected “No,” please click here to complete our full registration form with your updated information. You may also continue and submit this form, and a member of our Customer Care team will be in touch to update your information.

ONLINE SHOPPER DETAILS:

An online shopper is someone who is authorized to make purchases on behalf of your account. This could be a veterinarian, practice manager or another trusted team member.

You must designate at least one online shopper to complete Verification.

Preferred Online Shopper #1*

firstname__shopper_1(Required)

lastname__shopper_1(Required)

email__shopper_1(Required)

title__shopper_1(Required)

phone__shopper_1(Required)

Online Shopper #2 (Optional)

firstname__shopper_2

lastname__shopper_2

email__shopper_2

title__shopper_2

phone__shopper_2

Online Shopper #3 (Optional)

firstname__shopper_3

lastname__shopper_3

email__shopper_3

title__shopper_3

phone__shopper_3

ONLINE PAYER DETAILS:

An online payer is the person responsible for handling invoices and payments on behalf of your account, often someone in finance or accounts payable. Please note that statements of account (including dunning letters) and invoices will be sent to the email addresses listed as online payers.

Preferred Online Payer #1

firstname__payer_1

lastname__payer_1

email__payer_1

title__payer_1

phone__payer_1

Online Payer #2 (Optional)

firstname__payer_2

lastname__payer_2

email__payer_2

title__payer_2

phone__payer_2

Online Payer #3 (Optional)

firstname__payer_3

lastname__payer_3

email__payer_3

title__payer_3

phone__payer_3

FORM SUBMITTED BY:

Please provide the name and email address of the person filling out this form. This helps our Customer Care team reach out if we need any additional information to process your application.

submittedby_firstname(Required)

submittedby_lastname(Required)

submittedby_email(Required)