Agent Interest Form

To get started with Clever RX, please complete the form below.

Once submitted, review the next steps at the bottom of the page.

If you would like a FREE co-branded website,
please indicate your company name here:

Please indicate if you would like to be paid by Clever RX directly or through GBL. The amount paid will be the same.

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Thank you for submitting! 

Please review the "Next Steps" information below.

Next Steps:

Once you have submitted the Agent Interest Form, the Clever RX team will start building your custom URL.

 

Within a week, you will receive an email with your custom URL and information needed to promote Clever RX.