New Customer Setup

Form previewThis version lets you fill out and review the application. It does not send your information or upload documents to Skya yet. Selected files stay on your device.

Required field

YOUR ORGANIZATION

General information

Legal Entity Name DBA Name (if any) Primary Business Contact Pharmacy in Charge Business Phone Business Email Accounts Payable Contact Accounts Payable Email Years in Business Dun#

PRODUCT DELIVERY

Ship to information

Shipping Address City State ZIP Code

ACCOUNTS PAYABLE

Bill to information

Same as shipping address

Billing Address City State ZIP Code

BUSINESS DOCUMENTS

License information

Choose PDF or JPG documents from your device. They are shown in the review but are not uploaded in this preview.

State Pharmacy License DEA License PIC License State Controlled Substance License Additional Documents

FINAL DOCUMENT

Credit card authorization

Download and complete Skya’s authorization form, then choose the completed PDF or JPG below.

Download Credit Card Authorization Form Completed Credit Card Authorization Form (needed for final submission)

The selected file remains on your device. Its contents are not included when you print the application.

Your application is not sent when you review it. You can check the details and print or save a local copy.

YOUR APPLICATION

Review your details

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