EFT Authorization Agreement

Adobe PDFDOWNLOAD EFT Authorization Agreement

 

PLEASE RETURN SIGNED FORM VIA MAIL, FAX OR EMAIL TO:
ALERT PHARMACY SERVICES, INC
219 N. BALTIMORE AVE
MT. HOLLY SPRINGS, PA 17065
PHONE: 717-486-8606 OR 1-800-266-9954
FAX: 717-486-4410 OR 1-800-266-9947
EMAIL: BILLING@ALERTPHARMACY.COM

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