Get Whc Support

The WHC Support Wholesale Order Form is an important document for healthcare providers looking to order Bayer products. This guide provides step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to successfully complete the WHC Support form.

1. Press the ‘Get Form’ button to access the form and open it within your online document management system.
2. Begin with the physician licensing information section. Fill in the licensed physician's name, state license number, state of license, NPI, and FEIN as applicable.
3. In the product selection area, indicate your preference for educational kits by selecting either 'Please send me an educational kit' or 'Do not send me an educational kit' for each product.
4. For , enter the quantity requested in the corresponding field. Review the product information and note the NDC number as 50419-421-01, and be aware of the cost per unit.
5. Repeat the previous step for Skyla, entering the quantity requested, confirming the NDC number 50419-422-01, and taking note of its cost.
6. Provide the shipping information by entering the physician, institution, or practice name, along with the required address fields: city, state, and ZIP code, ensuring correct details for timely delivery.
7. If the billing address differs from the shipping information, fill out the 'Bill to Address' section with the appropriate details.
8. In the payment terms section, choose how you wish to be billed: either 'Bill / Invoice me directly' or by credit card. If opting for credit card billing, complete the card type, name on the card, account number, and expiration date.
9. Complete the signature authorization by signing the form. Add your printed name and title as required.
10. After you have filled out all sections, save changes to your document. You can choose to download, print, or share the completed form as necessary.

Complete your WHC Support Wholesale Order Form online today for efficient ordering.