Get Dispenser Waiver Form

The Dispenser Waiver Form is essential for requesting an exemption from reporting requirements for pharmacies in South Dakota. This guide will help you navigate the form's sections and provide step-by-step instructions for completing it online.

Follow the steps to complete the Dispenser Waiver Form successfully.

1. Click the ‘Get Form’ button to access the form and open it for editing.
2. Enter your full name in the 'Name of Dispenser' field. Please avoid using initials and make sure to typographically ensure clarity.
3. Fill in your license or permit number as required in the designated field.
4. Provide your complete street address, including any apartment or suite number if applicable.
5. Write down your city, state, and zip code in their respective fields.
6. Input the name of the pharmacist-in-charge in the designated field.
7. Include the license number of the pharmacist-in-charge.
8. Enter the area code and telephone number to ensure you can be contacted if necessary.
9. Sign the form in the 'Signature' field and date it accordingly.
10. Select the applicable reasons for requesting exemption from reporting by checking all relevant options provided.
11. After completing all required fields, make sure to save your changes. You can then download, print, or share the form as needed.

Complete your Dispenser Waiver Form online now to ensure compliance and efficiency.