Forms You May Need
Click the links 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.


Product Order Form/Terms and Conditions
You may fill out and mail or fax this form to order products from us.

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


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.


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.


Controlled Substance Customer Questionnaire
Required for the purchase of all controlled substances.

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.

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.

Tramadol Declaration
Required for customers purchasing large quantities of Tramadol.


Adobe Acrobat Reader is required to view .pdf files like those listed above. If you do not
have it installed on your computer, click on the image link below to download it free
from Adobe.



800.234.1464 | 1690 New Britain Avenue | PO Box 4066 | Farmington, CT 06032-4066
All rights reserved. ©2014 Moore Medical LLC.

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