RETAILER APPLICATION FORM
Thanks for your interest in Shelf Life! Help us learn more about your business by completing this form.
Our team will be in touch as soon as possible!
Name of Business
Number of Locations
Name of Owner/Primary Contact
Address & Landmarks
Years in Operations
Reason for Interest (select all that apply)
PAY AS YOU SELL
LOGISTICS & PROCUREMENT
If a Shelf Life pharmacy referred you, let us know who it was.
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