ACXSS Email Marketing -

ACXSS/ThePhysiciansCollaborative Enrollment Form

Welcome to ACXSS, your affordable cloud-based supply chain management solution that automates purchasing, manages inventory, and captures total spend through our AI-powered Procure-to-Pay application.

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Email *

Practice Name *

Name of Authorized Doctor *

Authorized Business Contact *

Phone Number *

# of Locations *

Specialty *

Street Address *

Address 2

City *

State *

Zip Code *

Please provide the account information for your Medical Supply Vendors (MSV):

Medical Supply Vendor 1

MSV 1 Bill To ACCT #:

MSV 1 Ship To ACCT #:

MSV 1 Rep Email:

MSV 1 Rep Name:

Medical Supply Vendor 2

MSV 2 Bill To ACCT #:

MSV 2 Ship To ACCT #:

MSV 2 Rep Email:

MSV 2 Rep Name:

Please provide the account information for your Office Supply Vendors (OSV):

Office Supply Vendor 1

OSV 1 Bill To ACCT #:

OSV 1 Ship To ACCT #:

OSV 1 Rep Email:

OSV 1 Rep Name:

Office Supply Vendor 2

OSV 2 Bill To ACCT #:

OSV 2 Ship To ACCT #:

OSV 2 Rep Email:

OSV 2 Rep Name:

Please provide the account information for your Lab Supply Vendor (LSV):

CLIA Waived ACCT #:

CLIA Rep Email:

CLIA Rep Name:

Please link my practice to the following discounted vaccine contracts:

GlaxoSmithKline (GSK) ACCT #:

Merck Vaccines ACCT #:

Pfizer Vaccines ACCT #:

Sanofi-Pasteur Vaccines ACCT #:

Moderna (Covid Vaccine) ACCT #:

Seqirus (Flu Vaccine) ACCT #:

VaccineShop (VaxServe) ACCT #:

AstraZeneca/FluMist (Vaccines):

Yes

Please verify your request. *

Read the ACXSS and ABS Participation Agreement Terms:

Read our ACXSS Participation Agreement and our ABS Participation Agreement

By submitting your application you agree to the Participation Agreement terms

Yes *

📩 IMPORTANT — PLEASE READ BEFORE JOINING

To complete your ACXSS enrollment, you will need to confirm your email after clicking "Join Now."

Your enrollment is not complete until you click the link to confirm that email.

The confirmation email will come from:
arosato@acxss.com

If you do not see the email:
Check your Spam, Promotions, or Junk folder
Or search your inbox for: “TPC”