PillChecks.com Pharmacy Affiliate Program

Join Our Program

Please complete and submit the sign up form. Please note: Approvals are NOT automatic, an email will be sent to you with your login details, but you will not be able to login until your account has been approved. Fields marked with * are required.

Tip: If you just want to add new domains, please use the back office server www.billrx.com (click Add new store under the 'Stores' menu); you don't need to sign up again. If you do sign up twice you will need to use a different email address each time, and re-enter your payment info.

Section 1: Your new store information

The email address you use below should be the same one used for your back office account. If you do not yet have a back office account one will be created for you, please enter your email address. Please make sure you type a valid email address.

Your email address:*

The domain you type below is the web site domain name for your new store. Please type it in without the http://www. For example if your store will be located at www.example.com you would type example.com below. If you already have a web site set up, and just want to add another one, you should use the back office and not this form.

Your web site domain:*

We Register your domain:

(Yes if we will register and host this site)

The catalog of products your new store will sell is next. Please select the catalog you want to sell from the list below.

Your product catalog:*

Section 2: Register for a new back office account

This section must be left blank if you already have a back office account. If not please enter your personal details below so we can create your new account, if a new account is created you will receive a welcome email from the system with full login instructions.

Your full name:

Choose a Password:

Retype Password:

Address:

City:

State:

Province (Non U.S only):

Zip/Postal Code:

Country:

Phone:

Section 3: Your web site template

Please choose from one of the templates below. The template you choose will be available in zip format when you click submit, you can change the template your web site uses at any time using your back office login. Please click on any of the thumbnails below for a preview.

Please note: XML Templates require SSL for the order form. Please DO NOT choose an XML Template unless you have a server (or ISP account) that supports SSL AND you have an SSL certificate for your web site. Shared certificates are NOT supported. Normally you should use www.example.com in the common name field when ordering your SSL certificate, and NOT example.com. If we are registering and hosting your domain please do not select XML as our web hosts support only PHP/JS English language templates.

Please select the template technology:

I agree to the Affiliate Terms & Conditions