Pharmaceutical Account Registration

Please note: you must have an existing ZebraVet account before applying for a pharmaceutical registration.

Primary Veterinarian Details

Veterinarian Full Name *

Registration / Licence Number *

State of Registration *

Clinic Details

Clinic Name *

Email *

Primary Contact Name

Primary Contact Title/Role

Primary Contact Number

Address *

City *

Post Code *

State *

Are delivery instructions the same as your current consumable orders?

Credit Limit Requested

Expected Monthly Pharma Spend

Additional Veterinarians (Optional)

Declaration

I/we confirm that the above details are correct and provided for the purposes of setting up a pharmaceutical supply in accordance with regulatory requirements.

I/we consent to:

the collection and use of personal and business information for account management, regulatory compliance and credit assessment in accordance with ZebraVet’s Privacy Policy
I/we consent to Zebravet making such enquiries as reasonably necessary to verify the details in this form.

Thank you — your pre-registration has been submitted.

Pharmaceutical Account Registration

Primary Veterinarian Details

Clinic Details

Credit Limit Requested

Additional Veterinarians (Optional)

Declaration

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