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 *
Email Address
Phone Number
Address & Landmarks
City
Country
Years in Operations
Reason for Interest (select all that apply)
If a Shelf Life pharmacy referred you, let us know who it was.
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