Pharmaceutical Industry Association of Puerto Rico

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Supplier Registration Form

If you are currently a supplier, vendor or consultant to the pharmaceutical industry, and would like to appear in this directory, please fill out and submit the following information. Thank you.

Name of Company:
Name of Contact:
Position:
E-mail:
Fax:
Phone:
Web site:
Year established:
Category:	Other:
Pharmaceutical companies you are doing or have done business with:
Logo:

Description of products/services:

I agree to the following terms and conditions:
The pharmaceutical Industry Association reserves the right to include or deny inclusion of any person or company in the supplier directory. Only Current pharmaceutical industry suppliers will be considered. A $100 monthly fee will be charged to appear in this section.

City View Plaza, Suite 407 • Guaynabo, Puerto Rico, 00968 • T. 787.622.0500 • F. 787.622.0503 • contact@piapr.org