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Online Application

By submitting this application you consent to Scripts Wholesale vetting process. This includes, but is not limited to: contacting references, researching your company, inquiring into your financial standing, and any other information we deem relevant or necessary. By signing this application you are verifying that all the information is accurate.

Online Application

Business and Credit Information

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Business / Trade References

Purchaser info

Account Payable Contact

Thank you for your interest in Scripts Wholsale.

In order to better serve you we will need you to provide the following information:

  1. Credit Application
  2. State License (Board of Pharmacy). The name and address must match the name and address on your application.

By submitting this application you consent to Scripts Wholesale vetting process. This includes, but is not limited to: contacting references, researching your company, inquiring into your financial standing, and any other information we deem relevant or necessary. By signing this application you are verifying that all the information is accurate.