Activate Your Business Account Online

Please complete the following form if you are an existing customer and would like to access online ordering and account management features.

Please note, fields marked with an asterisk (*) are required in order to submit the form.

Title *

First Name *

Last Name *

Company Name *

Mediq Account Number *

Telephone No. *

Email Address *

Invoice Address Post Code *

Are you authorised to have access to all delivery addresses linked to your customer record? *

Yes

I consent to receiving newsletters and general marketing. *

Yes

Additional Information:

Our Privacy Notice and how we process personal data, can be found at medbis.mediq.co.uk

Submit