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Welcome to GreenRX

Please fill out the form below so we can process your registration.

Registration form for pharmaceutical wholesalers

Please note that in the case of a pharmaceutical wholesaler with several branches, each branch must be created or registered separately with its own address.

Gender *

Title

Your Name *

Please enter your first and last name, separated by a space.

Position *

Company Name *

Phone *

Email *

VAT ID No.

Address *

PLZ *

City *

Country *

Wholesale License (PDF/JPG, max. 5 MB) *

Send