Propet PedRx Form
Complete this form to sign up for the Propet PedRX Program
Select Your Sales Representative
Please Select
Bob Armbruster (AL, GA, MS)
Brad Clary (S CA, S NV, HI)
Bruce Cannon (AK, OR, WA, N CA, N NV)
Cindy Larris (NJ, NYC)
Jeff Larris/Josh Larris (D.C., DE, MD, PA)
Denise Day (CT, MA, ME, NH, Upstate NY, RI, VT)
Gary Ehrlich (FL, PR)
Ray Fowle (NC, SC, TN, WV, VA)
Kyla Greenfield (AZ, ID, NM, MT, WY, CO, UT, & El Paso, TX)
Michele Baker (AR, LA, OK, TX)
Paul Vazquez (IA, IL, IN, KS, KY, MI, MN, MO, NE, ND, OH, SD, WI)
I'm not Sure
Propét Account Number
Company Name
Name
First Name
Last Name
Email (please provide an email address for the contact that will process your orders and returns)
example@example.com
I am a Medical Account
Yes
I'd like to Join the PedRx Program
Yes
Submit
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