Section 2 of 5
Product & Compliance
Details about what you sell and how you stay compliant.
What specific peptides do you sell? *
How are your peptides sold? *
Do you require a prescription or physician authorization before fulfilling orders?
Do you have a legit script / prescribing process in place?
Are you registered with any regulatory bodies? (FDA, DEA, state pharmacy boards)
Where are you sourcing your peptides from? *
Select
U.S. compounding pharmacy
U.S. manufacturer
China
Other
If other, specify sourcing details
Do you have Certificates of Analysis (COAs) and third-party testing?
Do you carry product liability insurance?
Section 3 of 5
Sales Model & Customer Acquisition
How you acquire and serve your customers.
Where is most of your traffic / customers coming from? *
Select
Cold paid ads
Organic / SEO
Referrals
Doctor / clinic network
Do you work with doctor networks or telehealth platforms?
Who are you selling to? *
Select
Direct to consumer
Direct to doctors / clinics
Both
What does your checkout flow look like?
Do you currently offer financing or payment plans to buyers?
Do you sell coaching, consultations, or any other services alongside the peptides?
If yes, describe the additional services
What platform is your store on?
Select
Shopify
WooCommerce
Custom-built
Whop
GoHighLevel
ClickFunnels
Other
Section 4 of 5
Transaction & Risk Profile
Volume, chargebacks, and fulfillment details.
Current or projected monthly revenue *
Select range
Under $10K
$10K - $50K
$50K - $100K
$100K - $250K
$250K - $500K
$500K - $1M
$1M+
Average order value
Current chargeback / dispute rate (if you have processing history)
Select
Under 0.5%
0.5% - 1%
1% - 2%
Over 2%
No processing history yet
Do you have an existing merchant account or processor?
If yes, who is your current processor and why are you looking to switch?
Have you ever been terminated by a processor, placed on the MATCH/TMF list, or had an
account shut down?
If yes, explain what happened
What's your refund policy?
Shipping — domestic, international, or both?
Select
Domestic only
International only
Both
Average fulfillment / shipping time
Do you run any recurring billing or auto-ship programs?
Any expected volume spikes we should know about? (launches, promos, seasonal)
Section 5 of 5
Processing Needs
What type of processing solution are you looking for?
What type of processing do you need? *
Do you already have a payment gateway integrated?
Do you need multi-currency support?
Anything else we should know?
Submit Application →
No personal or financial information is collected in this form.