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Securicord Store Authorized Distributor Application

We appreciate your interest in becoming an authorized distributor of Securicord products and services and look forward to welcoming you. Please complete the Authorized Distributor Application Form below.

As an authorized Securicord distributor, you will be able to:

Offer Securicord DNA tests and kits from your clinic
Drop ship test kits directly to your clients
Receive access to an online console to manage your clients and sales

Already an authorized distributor? Login now »

If you have any questions, please contact us at support@securicord.com.

Distributor

Contact Individual

First Name

Last Name

Email Address

Re-enter Email Address

Phone #

Business/Clinic Information

Business Type

Business Name

Business Phone #

Website

Address 1

Address 2

Country

Province/State

City

Zip/Postal Code

What types of tests are you interested in?

Test Types

At-Home Paternity and Relationship DNA Test Kits

Legally Admissible Paternity DNA Tests

At-Home STD Test Kits

At-Home Health and Wellness DNA Test Kits

Select a Password (minimum 6 characters)

Password

Re-enter Password

Please provide a description of your business and how you will be reselling Securicord Store test kits through your business.

Securicord Store Authorized Distributor Agreement - Please Check to Confirm Understanding

Distributor is authorized to market and sell Securicord Store Products and Services. Securicord Store may withdraw its consent for Distributor to market and sell Products and Services, and Distributor agrees to cease all such marketing and sales immediately upon notice of such termination. Securicord Store has no obligation to perform tests or services until payment is received. Distributor must safeguard the confidentiality of DNA test client information. Distributor shall not make any false claims regarding the Products and Services. Distributor agrees to hold Securicord Store free and harmless from any and all claims, damages, and expenses of every kind or nature whatsoever. With Securicord Store's prior written approval, Distributor may create advertising material to promote the Products and Services, including but not limited to website, brochures and posters if done so in strict accordance with Securicord Store's guidelines. Distributor may market Securicord Store Products and Services and shall abide by Securicord Store Terms and Conditions.

Confirmation

I/We have read and understand the terms and conditions as stated above and that all information on this form is accurate.

Print Name

Sign up now to start offering Securicord DNA tests at your clinic

Securicord Store Authorized Distributor Application

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