Become a Customer

New customer application process

We collect five categories of information about your pharmacy during the application process:
  • DEA license or HIN certificate
  • State Board of Pharmacy license
  • General business and contact information
  • Payment and credit information
  • State Sales & Use Tax exemption ID# or certificate

Complete and submit the below form to start the application process.

Prefer to take it slower? Call 866.368.1464, select option 3, and talk to a sales representative.

Payment & Credit Applications

SmartSource offers three payment and credit options. Select the one that works best for your business. Print, sign, scan and email the completed form to SalesAdmin@SmartSourceRx.com. We'll review the form and contact you shortly about your application details. If you'd like help with your application, call 866-638-1464 and select option 3.

Need help?

Need assistance with your application? Want to learn more about working with us? Please call 866-638-1464 and select option 3 or email SalesAdmin@SmartSourceRx.com for support. 
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We are VAWD accredited.