About SSL Certificates

New Pharmacy Registration - Step 1 of 2

To register for a pharmacy account at eDrugSearch.com, please fill out the information below. Please remember to be honest and list your correct information or you risk not getting listed in our drug search. However, you are not required to list every line of info but we encourage it so that members will gain your trust (which is very important in this industry) and the more info you list the more exposure your website will receive.

Important: The contact information below marked in red will remain private and eDrugSearch.com will use this as an open line of communication to:

* Properly verify your pharmacy
* We would like to hear your suggestions
* Most Importantly, we want to establish a mutual relationship

 Pharmacy Information

Pharmacy Name:
XYZ Pharmacy

URL:
http://www.xyzpharmacy.com

Contact Person:
John Doe

Contact Email:
[email protected]

CEO/President:
John Doe

Physical Address:
1234 Fake St.

City/State/Province:
Miami, FL

Country:

Language:
Only select the language(s) your website is written in.

































Standard Phone #:
1-123-456-7890

Toll-free Phone #:
1-800-123-4567

Fax #:
1-123-456-7890
   

The following contact info will remain private and will be used as an open line of communication.

Private Email:
[email protected]

Private #:
1-123-456-7890
   

 Special Offers

Please check any of the following that you offer:

Free Shipping      Free Consultation       Coupons       Rebates

Please enter a title for the special offer:


Free Standard Shipping at XYZ Pharmacy Exp. 02/07/06

Please enter a brief description about the special offer:


Free standard shipping and handling on all mailable items.

 Login Information

Username:

Password:

Enter Password Again:

   

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