Biogen Direct Web Access Request Form

BiogenDirect
Customer Service

5025 Plano Parkway
Carrollton, TX 75010

Phone:
1-855-706-8346

Fax:
1-855-504-6900

New Account Sign Up

New Customer

To place an order, you must have an account established with BiogenDirect. To establish an account, please contact BiogenDirect Customer Service at 1‐855‐706‐8346.

Existing Customer

If you currently have an established account with BiogenDirect and would like to begin purchasing products online, please fill out the form below and click submit when complete.

Company Name *Company Name Required

Phone *Required *Format ### - *Required *Format ### - *Required *Format ####

Email *Email Required *Invalid e-mail format

First Name *First Name Required

Last Name *Last Name Required

Login ID *Login ID Required

Your Account Number(s)
*Account Number(s) Required

More than one account number can be entered separated by commas (no spaces). Don't know your account number? Please call customer service at 855-706-8346.

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