Administrator – New Account

 

Account No.
Password
Customer Name
ABN
Ordering Contact
Contact Name
Telephone
Email Address
Address 1
Address 2
City
State/Prov
Country
Zip/Postal Code
Proof of Authority to Purchase or Supply Schedule 4 Poisons
In order to purchase from STA you must provide Proof of Authority to Purchase Schedule 4 Poisons. Please tick which of the following documents will be provided to STA by fax and then fax the document(s) to 1800 798 829.
Documents	A Health Authority Permit to purchase Schedule 4 Poisons (for hospitals); A Pharmacy Board Registration Certificate (for Pharmacists); A Medical Board of Australia Registration Certificate (for Medical Practitioners).
Expiry Date of Doc
Accounts Contact  Copy from above address
Contact Name
Telephone
Email Address for Invoices
Invoice Address 1
Invoice Address 2
Invoice City
Invoice State/Prov
Invoice Country
Zip/Postal Code

 

 

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