Pharmacy Registration – Pharmaceuticals Direct Limited

Pharmacy Account Registration - Pharmaceuticals Direct Limited

Pharmacy Information

Pharmacy Owner (Ltd Company)*

Pharmacy Trading As (T/A) Name*

Pharmacy GPhC Number*

Superintendent Pharmacist Name*

Superintendent GPhC Number*

Business Type

Online Dispensing

Retail

Number of Sites

Clinical Services Provided

List all clinical services your pharmacy provides

Addresses

Invoice Address*

Delivery Address

Only complete if different from invoice address

Company Registration

Company Registration Number*

VAT Registration Number*

Website Address

Optional - include if your pharmacy has a website

Contact Details

Sales Contact

Name*

Email*

Landline

Mobile*

Product Recall Contact (available out of hours)

✓ Same as Sales Contact

Name*

Email*

Landline

Mobile*

Finance Contact

✓ Same as Product Recall Contact

Name*

Email*

Landline

Mobile*

Delivery Information

Opening Times (if different from standard)

Leave blank if standard delivery times (Mon-Fri, 08:00-18:00) are acceptable

Data Protection & Communications

General Data Protection Regulation (GDPR)

The Data Protection Act 2018 is the UK's implementation of the General Data Protection Regulation (GDPR). Under the Data Protection Act 2018, you have the right to find out what information the government and other organisations store about you. To comply with these requirements of the law, Pharmaceuticals Direct Limited has a Privacy Policy, which you can find on our website, www.pdluk.com. The policy provides detailed information on how we use and protect your personal information, and your rights in relation to this.

We will provide you with email statements/invoices unless you confirm you do not wish to subscribe to this service. Should you wish to change your preferences at any time please send your request to info@pdluk.com.

I wish to opt in for communications relevant to the service provision

Customer Declaration

By signing this document, you verify that the information supplied is correct to the best of your knowledge and declare that you will immediately inform Pharmaceuticals Direct Limited in the event of any changes. By signing this declaration you confirm that you agree to our terms and conditions of sale which can be found on our website at www.pdluk.com

Print Name*

Position Held*

Contact Number*

Email Address*

Signature*

Please sign above using your mouse or touch screen

I confirm that: All information provided is accurate and complete. I have read and agree to the Terms and Conditions and Privacy Policy. I am authorized to submit this registration on behalf of the pharmacy.*

✓ Registration Submitted Successfully!

Thank you for registering with Pharmaceuticals Direct Limited.

Your application is now under review by our team.

You will receive confirmation and account credentials via email within 2-3 business days.

Reference Date:

Need assistance? Contact us

PHARMACY ACCOUNT REGISTRATION

✓ Registration Submitted Successfully!