{"id":33,"date":"2022-01-28T12:19:18","date_gmt":"2022-01-28T17:19:18","guid":{"rendered":"http:\/\/template.compoundsolstg.wpengine.com\/?page_id=33"},"modified":"2022-02-08T13:39:39","modified_gmt":"2022-02-08T18:39:39","slug":"register","status":"publish","type":"page","link":"https:\/\/pharmacytemplate.harplabs.com\/?page_id=33","title":{"rendered":"Register"},"content":{"rendered":"<form  class=\"kaliforms-form-container bootstrap-wrapper   kaliforms-hidden-during-load\" data-form-id=\"101\" style=\"opacity:0\"><h3>Pharmacy registration<\/h3><div id=\"kaliforms-global-error-message-101\" class=\"global-error-message\"><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-6 \"><label  for=\"textbox1\">First name <span class=\"kali-required-mark\"><\/span><\/label><input  data-internal-id=\"textbox1\" type=\"text\" id=\"textbox1\" name=\"fname\" data-properties.type=\"text\" required ><\/div><div class=\"col-12 col-md-6 \"><label  for=\"textbox2\">Last name <span class=\"kali-required-mark\"><\/span><\/label><input  data-internal-id=\"textbox2\" type=\"text\" id=\"textbox2\" name=\"lname\" data-properties.type=\"text\" required ><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-6 \"><label  for=\"textbox13\">Contact email <span class=\"kali-required-mark\"><\/span><\/label><input  data-internal-id=\"textbox3\" type=\"text\" id=\"textbox13\" name=\"email\" data-properties.type=\"text\" required ><\/div><div class=\"col-12 col-md-6 \"><label  for=\"telephone4\">Contact phone<\/label><input  data-internal-id=\"telephone4\" type=\"tel\" id=\"telephone4\" name=\"telephone\" data-format=\"free\"  class=\"input\"><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-6 \"><label  for=\"textbox136\">Company name <span class=\"kali-required-mark\"><\/span><\/label><input  data-internal-id=\"textbox6\" type=\"text\" id=\"textbox136\" name=\"company\" data-properties.type=\"text\" required ><\/div><div class=\"col-12 col-md-6 \"><label  for=\"telephone47\">Company phone <span class=\"kali-required-mark\"><\/span><\/label><input  data-internal-id=\"telephone7\" type=\"tel\" id=\"telephone47\" name=\"companytelephone\"required  data-format=\"free\"  class=\"input\"><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"textbox1368\">Address <span class=\"kali-required-mark\"><\/span><\/label><input  data-internal-id=\"textbox8\" type=\"text\" id=\"textbox1368\" name=\"address\" data-properties.type=\"text\" required ><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"textarea13\">What products does your location make?<\/label><textarea  data-internal-id=\"textarea13\" type=\"textarea\" id=\"textarea13\" name=\"whatproducts\" rows=\"5\" class=\"input\"><\/textarea><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"businesstype\">Business Type <span class=\"kali-required-mark\"><\/span><\/label><select  data-internal-id=\"dropdown10\" type=\"dropdown\" id=\"businesstype\" name=\"businesstype\"required  class=\"input\"><option value=\"\" selected><\/option><option value=\"centralfillorder\" >Central Fill Order<\/option><option value=\"prescriptionredirect\" >Prescription Redirect<\/option><option value=\"bothtypes\" >Central Fill Order and Prescription Redirect<\/option><\/select><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><span  data-internal-id=\"freetext11\" type=\"freeText\" id=\"centralfillagreement\" name=\"freeText\"><h3>Central Fill Agreement<\/h3>\nPlease download these documents, fill them out, and upload them in field below for approval.\n<a href=\"#\">Insert link to documents here<\/a><\/span><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"centralfillagreementUpload\">Verification documents <span class=\"kali-required-mark\"><\/span><\/label><div data-internal-id=\"fileupload14\"><input  data-internal-id=\"fileupload14\" type=\"file\" id=\"centralfillagreementUpload\" name=\"centralfillagreementUpload\" data-acceptedExtensions=\"application\/pdf,application\/msword,application\/vnd.openxmlformats-officedocument.wordprocessingml.document\" instantUpload required  style=\"display:none\"><\/div><br\/><small>Please select your business type for required documents<\/small><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><input  data-internal-id=\"submitbutton12\" type=\"submit\" id=\"submitButton12\" data-style=\"default\"  name=\"submitButton12\" class=\"input\" value=\"Submit\" ><\/div><\/div><!-- This form was built using Kali Forms --><\/form>","protected":false},"excerpt":{"rendered":"","protected":false},"author":9,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"zion_builder_full_width","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-33","page","type-page","status-publish","hentry"],"acf":[],"featured_image_urls":{"full":"","thumbnail":"","medium":"","medium_large":"","large":"","1536x1536":"","2048x2048":"","post-thumbnail":"","twentytwenty-fullscreen":"","woocommerce_thumbnail":"","woocommerce_single":"","woocommerce_gallery_thumbnail":"","wc_order_status_icon":"","form-edit-image-preview":""},"post_excerpt_stackable":"<p>Pharmacy registrationFirst name Last name Contact email Contact phoneCompany name Company phone Address What products does your location make?Business Type Central Fill OrderPrescription RedirectCentral Fill Order and Prescription RedirectCentral Fill Agreement Please download these documents, fill them out, and upload them in field below for approval. Insert link to documents hereVerification documents Please select your business type for required documents<\/p>\n","category_list":"","author_info":{"name":"pharmacydemo","url":"https:\/\/pharmacytemplate.harplabs.com\/?author=9"},"comments_num":"0 comments","zion_builder_status":true,"_links":{"self":[{"href":"https:\/\/pharmacytemplate.harplabs.com\/index.php?rest_route=\/wp\/v2\/pages\/33","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pharmacytemplate.harplabs.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pharmacytemplate.harplabs.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pharmacytemplate.harplabs.com\/index.php?rest_route=\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/pharmacytemplate.harplabs.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=33"}],"version-history":[{"count":0,"href":"https:\/\/pharmacytemplate.harplabs.com\/index.php?rest_route=\/wp\/v2\/pages\/33\/revisions"}],"wp:attachment":[{"href":"https:\/\/pharmacytemplate.harplabs.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=33"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}