Serata Product Dropship Sign-Up Form
This is a sign-up form for clients of Serata who intends to join the Product Dropship program. We will contact you shortly after you submit the form for account verification.
For questions, please contact us at +628113357676 or
info@serataraya.com
. Thank you.
* Required
Clinic/Hospital Name
*
Your answer
Prescriber Name (Dokter Penulis Resep)
*
Your answer
Doctor/Clinic Address
Your answer
Doctor/Clinic City
Your answer
Doctor/Clinic Province
Your answer
Clinic Email
*
Your answer
Clinic Phone Number
*
Your answer
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