Pharmacy Digital TV Signage Signup Form

Step 1 of 2: Submit

Please fill out this form completely and click continue. Once we receive this information we will prepare your signage player for shipment.

McKesson Account Number Pharmacy Name Shipping Address City State Zip Contact First Name Contact Last Name Phone Number Time Zone Email

Do you Need a TV for your pharmacy? We will be Sending out TV's between 37 and 42 inches. Yes No I have my own TV

Store Hours Insurance Plans You Offer?

Please Check All Products Or Services That Apply To Your Pharmacy Free Blood Pressure Screening CBD Products Covid Vaccines Diabetes Counseling Compounding Durable Medical Equipment Flavored Medicines Accept Medicare Offer Med Sync Program Medicare Part D Counseling Vaccinations Influenza Vaccination Pneumonia Vaccination Shingles Vaccination Do You Participate In The Health Mart Circular/Flyer Program?

Please List Out Any Gift Items You Would Like Us To Promote Services You Offer Please Tell Us About Anything Else You Would Like To Promote On Your Digital Signage Screens What is the web address of your Pharmacy website?

Do you have a logo you would like us to use? Yes No

If yes please email the logo to Jim.Stock@worldwideaudiomedia.com please send as JPG, PNG, or EPS.. Thank You

We will need some technical info about your IT network, who would be the point person we can talk to on that topic? Preferably your IT person. IT person's phone number or ext.

I Understand that once I receive my digital signage player from World Wide Audio Media I will be billed a monthly fee of 50.00/month Yes I understand and agree

I understand that if at any time I cancel the service I must return the digital signage player or I will incur a one time 495.00 charge. Yes I agree and Understand

I understand that if I have opted to receive a Free TV that I am entering into a 24 month commitment Yes, I understand and agree.