Sprint Quality Printing, Inc. : Request a Secure RX Order Site

Sprint Quality Printing, Inc. is a State Approved Distributor and Printer
of Tamper-Resistant Prescription Forms.

State of Delaware
Department of State
Division of Professional Regulation

Submit this form to request a "Secure Order Site" for use by Healthcare Practitioners and Institutions authorized to purchase tamper-resistant prescription forms in Delaware.

A Secure Order Site is a special, "web site within our web site". This special service was designed to be user friendly and make it easy for you to order your prescription forms. Know that this certainly doesn't replace our personalized service, so feel free to call us anytime.

Once we process your request, you will be notified with a temporary password.

Practice Name

Prescriber Name *REQUIRED*

Address *REQUIRED*

City, State, Zip *REQUIRED*

Phone Number *REQUIRED*

Fax Number

E-mail Address *REQUIRED*

Preferred Username (case sensitive) *REQUIRED*

Security Code (assigned by DPR) *REQUIRED*

Preferred Response