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Click the button to generate a unique secure form to sign and submit to GSRx, or scroll down to download a .pdf application.

Submit .pdf Credit Authorization

Download and complete the .pdf form, then attach the completed form to the right and send. 

Upload File

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GSRx® Inc.

14505 North Hayden Road • Suite #101

Scottsdale, AZ 85260

(800) 833-GSRX (4779)

(480) 748-4546 (f)

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