Please complete each field below. Accurate entries are essential for timely fulfillment and for maintaining a controlled chain of custody.

Clinic or Hospital Information

Ordering Physician / Practitioner

Meridian Biologics Representative

Products may be procured and administered only by licensed medical providers. Meridian Biologics does not practice medicine, diagnose, or prescribe medications. Providers are responsible for reviewing all relevant research and compliance requirements, exercising independent medical judgment to establish protocols, obtaining informed consent, and guiding patients before any experimental or novel procedure. The FDA has not approved the clinical use of stem cells or exosomes. Meridian Biologics does not manufacture the Products; they are manufactured by an independent FDA-registered lab for homologous use, as determined by a physician, and for research or investigational purposes. No warranty, express or implied, is made regarding the Products' safety or efficacy in diagnosing, treating, curing, or preventing any disease or injury, and no such claims are authorized. Each Product is for single-patient, single-use only. Storage, handling, and chain of custody must conform to the manufacturer's guidelines.

Account Setup

ACH / Check Banking Information

I certify that I am an authorized representative of the Company named above with authority to execute this Agreement. This authorization shall remain in effect until formally revoked in writing, and the Company agrees to provide Meridian Biologics with written notice at least 15 days prior to any change in its account information or the termination of this authorization. The Company understands that funds may be withdrawn immediately upon authorization of an individual transaction and that it has a limited timeframe to report and dispute errors. The Company agrees to a charge of $35.00 for each returned item, processed as a separate transaction. In the event a transaction is rejected, Meridian Biologics may reprocess the payment within 24 hours or utilize an alternative payment method on file, and may require a credit card on file as a backup method. The Company certifies that the account is configured for ACH transactions and agrees to reimburse Meridian Biologics for any penalties or fees incurred as a result. Both parties agree to adhere to the NACHA Operating Rules and all applicable U.S. laws governing ACH transactions; the Company agrees not to dispute charges that conform to the terms of this Agreement and acknowledges that Meridian Biologics shall not be liable for shipment delays arising from payment rejections by the Company's financial institution.

By placing an order, you agree to pay the associated amounts and applicable fees for your order. If you pay by ACH, you authorize Meridian Biologics and/or its suppliers to initiate electronic debit entries from the bank account designated above for those amounts. If you pay by check or wire transfer, payment is due per the remittance instructions and payment terms provided with your order. Meridian Biologics works with one or more labs to fulfill orders — some payments are billed directly by Meridian Biologics, and to help expedite fulfillment, some are billed directly by the lab fulfilling your order, and the amounts billed or debited by a lab may appear on your bank statement under that lab's name rather than “Meridian Biologics.”

Credit Card Information

I certify that I am either the cardholder or an authorized user of the credit card listed above and possess the authority to enter into this Agreement on behalf of the Company. This authorization will remain in effect until formally revoked in writing, and the Company agrees to notify Meridian Biologics in writing at least 15 days prior to any change in its account information or the termination of this authorization. In the event a transaction is rejected, Meridian Biologics may reprocess the credit card or process the payment using another method on file. It is the responsibility of the undersigned to ensure sufficient funds are available and to specify the correct form of payment when submitting purchase orders. The Company acknowledges that Meridian Biologics shall not be liable for shipment delays arising from payment rejections by the Company's financial institution. This Agreement governs the transactions initiated for each purchase order, and the Company agrees not to dispute charges that conform to the terms of the purchase order.

By placing an order, you authorize Meridian Biologics and/or its suppliers to bill the associated charges and applicable fees to the credit or debit card designated above; a 3% convenience fee applies to all card payments. Meridian Biologics works with one or more labs to fulfill orders — some charges are billed directly by Meridian Biologics, and to help expedite fulfillment, some are billed directly by the lab fulfilling your order, and the charges billed by a lab may appear on your statement under that lab's name rather than “Meridian Biologics.” For your convenience, your card information will be kept on file for future orders.