By signing below the undersigned:
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Confirms that all information provided here is true, accurate, and complete.
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Agrees to notify the pharmaceutical manufacturer promptly of any changes to the
information submitted.
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Acknowledges and agrees to abide by all applicable laws and regulations, including compliance with all federal and state laws.
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Authorizes the pharmaceutical manufacturer to conduct credit checks, reference
checks, and other necessary due diligence to verify the information provided.
This includes obtaining financial information and verifying the company’s
creditworthiness.
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Acknowledges and accepts the terms of this agreement.
