Moore Medical LLC
 
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Click the buttons below to download .pdf files of forms you may print out, complete and mail or fax to us

Prescription Drug Authorization Form

To purchase prescription pharmaceuticals, please complete this form and email or fax back to us.

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Product Order Form/Terms and Conditions

You may fill out and mail or fax this form to order products from us.

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Credit Application Form

To open a Moore Medical line of credit, please complete this form and mail or fax back to us.

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Authorization to Purchase - Public Sector

For public sector organizations only (i.e. Government, Corrections and Schools). Complete and return this form to confirm a request to open an account for your organization.

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Prescription Drug Return Authorization Form

All requests to return prescription drugs must be approved by Customer Service within 7 days of invoice and the product(s) returned to us within 15 days accompanied by this signed form.

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Methamphetamine Control Act-Pseudoephedrine Form

The Methamphetamine Control Act of 1997 regulates the distribution of all List I Chemicals (all products containing Pseudoephedrine). The attached letter certifies that your use of these products is in direct compliance with this Act.

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Controlled Substance Customer Questionnaire

Required for the purchase of all controlled substances.

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Florida Sole Proprietor Letter

For Florida customers only. This form is needed to determine if a customer is a Sole Proprietor. If the customer is not a Sole Proprietor, an HCCE permit is required.

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Ohio Sole Proprietor Letter

For Ohio customers only. This form is needed to determine if a customer is a Sole Proprietor. If the customer is not a Sole Proprietor, a Terminal Distributor of Dangerous Drugs (TDDD) license is required.

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