RX Medical Warehouse - Company Registration





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New Company Registration

This procedure is "ONLY" necessary if you are ready to order. Fill the form below, and upload your licences, then click "Save Registration" to submit.
Without a copy of your licences we cannot sell or provde medicines.

* Required fields that must be filled out.

COMPANY INFORMATION REQUIREMENTS
Contact Name:	*
Company Name:	*
Physical Address:	*
Telephone:
Fax:
Login Information (Enter your email and a password of your choice for easy access)
Email Address:	*
Password:	* (NOTE:* Passwords should be between 6 and 12 characters long. Wildcard characters are not allowed.)*
License Information (Only necessary if you plan on purchasing from our company)
License To Upload:	(NOTE:* License must be in a image format such as .jpg, .gif or a Acrobat format .pdf - Max Size Allowed: 50MB)*

*YOUR COMPANY AND EMAIL INFO IS HELD IN STRICT CONFIDENCE AND WILL NEVER BE RELEASED OR SOLD TO 3RD PARTIES.
**A Copy of your licence is mandatory if you plan on purchasing medicines from our company..

Calle Aldama #112, 2do Piso Col Centro • Puerto Vallarta, Jalisco 48300 • Phone: +52.322.223.5675 • Fax: +52.322.223.5676