Registration to Pragmatic Regulatory Submission - Transmission Services

1. Information about you, the contact person

Name

Phone (+#-###-###-####) MUST START WITH LEADING "+"

Email Address

Electronic signature that you will use every time you sign submissions

2. Information about the company you represent

Company name

NDC labeler codes (prefixes) used by this company (separate by space, leave empty if none)

DUNS numbers used by this company as labeler or registrant

Name of person with authority to sign legally binding documents

Title indicating the capacity to sign legally binding documents for the company

3. Notice

NOTE:By pressing submit below you state that the aforementioned representations are true. All access to this site are logged. Making false representations can have severe consequences. Pragmatic Data will consider this fraud and reserves the right to ban you from accessing our services, and to initiate legal actions against you.For any technical issues and SPL services, please contact spl@pragmaticdata.com