MedVantx Mail Order Registration Forms - Watco Companies 2025

1. Click ‘Get Form’ to open the MedVantx Mail Order Registration Form in the editor.
2. Begin by entering your Member Information. Fill in the Cardholder ID#, Group #, Last Name, First Name, and Delivery Address including Street, City, State, and Zip Code.
3. Provide your Email Address and Daytime Phone Number. Then, enter your Date of Birth in MM/DD/YYYY format and select your Gender.
4. Indicate any Drug Allergies by checking the appropriate boxes or writing 'No Known Allergy' if applicable. Similarly, list any Health Conditions you have.
5. In the Payment Options section, choose your preferred payment method (credit card or check) and fill in the required details such as Credit Card Type, Expiration Date, Account Number, and Security Code if applicable.
6. Sign and date the form at the bottom to certify that all information is correct before submitting it for processing.

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