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Become a Customer

Credit loan requirements

To apply for credit greater than $25,000 additional information is required.  Please make sure you’ve gathered the necessary documentation needed in order to complete the application process. 

We collect general business, contact, and billing information for your pharmacy during the application process as well as the following required documentation (saved as a JPG, PDF or PNG):

  • DEA license or HIN
  • State Board of Pharmacy license
  • State Sales & Use Tax exemption ID# or certificate (FL, WA, LA only) 
  • For EFT or Biller Direct forms of payment, please upload a voided bank check, or a letter from your bank validating: company name, bank account number, and transit routing number
  • For credit card payment, no information is required at this time

Review credit agreement and payment terms


You will also be asked to complete a Credit Agreement and a Personal Guaranty. Please prepare to provide the following:

  • Primary and secondary supplier billing statement
  • Ownership information (required for all owners of 10% or more):
    • Name, address, and email address
    • Pharmacist status and license number (if applicable)
    • Percentage ownership and social security number (SSN)
  • Guarantor information:
    • Guarantor name, address, and email address
    • Guarantor spouse (if applicable): name, address, and email address

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.