Rexam Rapid Rewards

Enroll in the Rapid Rewards program today!

Complete this form in its entirety and click the "submit" button.
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Owner/Pharmacy Manager: *
E-mail: *
Pharmacy Name: *
DEA Number:
Address: *
City: *	State: * Zip: *
Phone: *
Fax:

Number of Prescriptions Per Week *

Number of Pharmacy Locations *

What Brand of Prescription Vials Are You Buying Currently?	Rexam Other

Primary Wholesaler *

Secondary Wholesaler

Does Your Pharmacy Have Automation?	Yes No If Yes, what type of machine?

May we send you emails regarding Rapid Rewards bonus points and/or other special offers?	Yes No

*Thank You!*