Registration Form

• Please fill out the following form or download New Account /Ouverture de Compte (pdf format ). Fill the form and mail it or fax it to (514) 342- 8631.
• Any Customer intending to purchase prescription drugs shall be required to submit proof of authority (license) to purchase prescription medication.
• Customer Care representative will contact you for any further instruction/ requirements.

Required fields are shown in bold.


First Name
Last Name
Company Name
Street Address 1
Street Address 2
City
Province
Postal Code
Country
Phone Number
Fax Number
Email Address
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