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Form 2687-2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out your personal information, including your last name, first name, and any former or maiden names. Ensure accuracy as this information is crucial for the background check.
- Select your race/ethnicity and sex from the provided options. This data is required for the criminal background check.
- Enter your Wisconsin License Number if applicable, followed by your complete address including street, city, state, and zip code.
- Sign and date the form at the designated areas. Remember to attach a recent photograph as specified in the instructions.
- If you are applying as a Wholesale Distributor of Prescription Drugs, ensure that you also provide the necessary details about your facility and designated representative.
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Related links
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