DEA regulation requires that all Ephedrine HCL customers must complete a (1 Time Only) Ephedrine Purchase Verification Form.

EPHEDRINE MAIL ORDER FORM REQUIREMENTS (PLEASE COMPLETE ONLY 1 PER CUSTOMER)

This form serves as identification and meets the DEA requirements for first time Ephedrine customers. We are requesting that you fill out this form in its entirety. Your order cannot be processed if any missing fields or information is incomplete. Please Note: Once this form is completed and your Information is on file, you will not be required to re-submit this form for future orders unless regulations change.

All information must match; your shipping address, the address on your driver’s license, and the address you supply on this form.

Complete the entire form. Any missing, or misleading information and your order will not be processed.

Please include a copy of your Passport or Driver’s License or State I.D. Card.

By completing this form you are acknowledging that the supplied information is valid and that you are 18 years of age or older.