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Please complete all required fields!
IF NOT, please visit your local pharmacy and ask for their selection of NamPharm products.
Copies of IDs will be required for upload
Forms will be provided during registration process.
Please Note: You are not required to provide three trade references and three wholesaler accounts; however, the quality and strength of the references you provide will improve your chances of being approved for a credit account.
Uploads are done in the following section.
Please download, complete, and upload the Applicant Signatory in the next section for your credit evaluation.
Download PDF
Please download our Terms & Conditions, complete and sign the form, and upload it in the next section.
Please download the application's surety, complete and sign the form, and upload it in the next section.
Please download, complete, and upload the Nampharm Additional Surety Form and submit it in the next section for your credit evaluation.
Please download, complete and sign the form, and upload it in the next section.
Click select to browse your device for the requested document. Allowed extensions: .pdf, .doc, .docx, .odt, .jpg, .jpeg, .png
You're almost done! Please review all your information and ensure all documents are uploaded. Once you're ready, click 'Submit' to complete your application.
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+264-61-284-9000
12 Gold StreetProsperita, Windhoek Namibia