KRS Global Biotechnology Sing-up - KRS Global Biotechnology

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About Us
STATE Licensure
Capabilities
- 503b Compounding
- Life Sciences
Contact

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Hospital, Surgery Center
and University Registration

Overview
Formularies

Home/Capabilities/503b Compounding/Sing-up

Register as:
*
- HOSPITAL
- SURGERY CENTER
- UNIVERSITY
- VETERINARIAN
- CLINIC
- SERGERY CENTER
- OPHTHALMOLOGIST
General information:
Name*
DEA REGISTRATION*
Organization Name*
Pharmacy License*
Phone*
Email*
Shipping information:
Facility Name*
Attention*
Street Address*
Phone*
City*
State*
Zip*
Email*
Are there any days of the week (M-F) that the facility is NOT open to recive deliveries or closes early?
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Special Instructions
+ Add Additional Facilities
Facility Name Contact Email Street Address City State Zip
Billing contact information:
- Please check this box if the shipping & billing address is the same
Facility Name*
Billing Contact*
Street Address*
Phone*
Fax
City*
State*
Zip*
Email*
Specialty information:
How did you find us?
Which items are you interested in from KRS Global?
Before an order can be placed, we need some or all of the following forms signed:*
- YES, I’m ready to upload some or all of these documents now.
- NO, I’ll upload them later, please submit my registration
A copy of your DEA License.
Please attach a .JPG or PDF file that is no larger than 5MB.
Accepted file types: pdf, docx, doc, jpg, Max. file size: 5 MB.
Please attach a .JPG or PDF file that is no larger than 5MB.
- I WILL EMAIL THIS LATER
A copy of your Pharmacy License.
Please attach a .JPG or PDF file that is no larger than 5MB.
Accepted file types: pdf, docx, doc, jpg, Max. file size: 5 MB.
Please attach a .JPG or PDF file that is no larger than 5MB.
- I WILL EMAIL THIS LATER
A signed copy of our Pharmacy Providers Agreement.
Download PDF form now
Accepted file types: pdf, docx, doc, jpg, Max. file size: 5 MB.
Download PDF form now
- I WILL EMAIL THIS LATER
A signed Credit Card Authorization Form.
If your account is on credit card terms, the card on file will be authorized at the time the order is placed holding the funds and charged once the order ships. Even if your account is on terms, KRS requires a credit card on file. If payment is not made by the 30th day, the card on file is charged. Download PDF form now.
Accepted file types: pdf, docx, doc, jpg, Max. file size: 5 MB.
If your account is on credit card terms, the card on file will be authorized at the time the order is placed holding the funds and charged once the order ships. Even if your account is on terms, KRS requires a credit card on file. If payment is not made by the 30th day, the card on file is charged. Download PDF form now.
- I WILL EMAIL THIS LATER
A Credit Application Form
Terms of Net 7 – Net 30 are available to hospitals and surgical centers. Specific terms will depend on the results of the KRS credit application. If you choose to be invoiced you will be prompted to download and complete the credit application. Download PDF form now.
Accepted file types: pdf, docx, doc, jpg, Max. file size: 5 MB.
Terms of Net 7 – Net 30 are available to hospitals and surgical centers. Specific terms will depend on the results of the KRS credit application. If you choose to be invoiced you will be prompted to download and complete the credit application. Download PDF form now.
- I WILL EMAIL THIS LATER
Name
This field is for validation purposes and should be left unchanged.

Corporate Headquarters

791 Park of Commerce Blvd., Suite 600
Boca Raton, Florida 33487
Open 9am-5pm EST

Toll Free Number

888.242.7996
866-480-3322 - Fax