Collagen P.I.N. Provider Portal – Induction Therapies

Provider Portal

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PLACE AN ORDER

Complete the form below to place an order for Collagen P.I.N.® devices and components. Please note we will use the credit card associated with your account to process your order.

"*" indicates required fields

Name Associated with Your Practice*

First

Your Business or Practice Name*

Shipping Address*

Street Address Suite # City State / Province / Region ZIP / Postal Code

Your Order*

Collagen P.I.N.® Device Kit | $3,698.00

24 Pck. of 36 PIN [30GA] Needle Cartridges | $888.00

6 Month Autoship (24 Pck. of 36 PIN [30GA] Needle Cartridges) | $744.00

Collagen P.I.N.® Brochures (50 pck.) | $24.95

Post Procedure Kits | $54.00

Please specify QTY needed in the Order QTY field below

Do You Have a Credit Card on File?*

Yes

I'd like to use a different card

Best Email Address*

You will be sent a payment link to this address

Specify Order QTY Here*

Comments

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