NEW DROP SHIP REQUEST FORM PHOTOCOPIES OF ... - Merck 2026

1. Click ‘Get Form’ to open the NEW DROP SHIP REQUEST FORM in our editor.
2. Begin by entering your Merck Account Number and Account Name at the top of the form.
3. Fill in the Address, City, State, and Zip Code for your location.
4. Select the TYPE OF CUSTOMER by checking one of the provided options such as Physician or Retail Pharmacy.
5. Next, indicate the TYPE OF OWNERSHIP by choosing from options like Wholesaler or Non-Govt/Non-Profit.
6. Provide New Drop Ship Info including Account Name, Address, City, State, and Zip Code for the drop ship address.
7. Complete contact details including Contact Person's name, Days Open, Hours Open, Phone number, Fax number, and Email Address.
8. Enter your State License # & Expiration Date and DEA License # & Expiration Date.
9. If applicable, specify if you are a member of a group purchasing agency.
10. Indicate your interest in using a Merck Internet site for account access by selecting YES or NO.
11. Finally, print your name, date the form, and provide your signature before submitting it via mail or fax as instructed.

Start filling out your NEW DROP SHIP REQUEST FORM today for free using our platform!