Registration Step 1:

Fill out the following form

Please fill out all fields. Once complete you must print, fill out, and return the KeySource Specialty™ Check Draft Authorization Form.

If you would prefer to download the application and fax/email, please click here to download.

[contact-form-7 id="111"]

Registration Step 2:

Download, print, fill out, and return the KY Meds ACH Form via email to or fax to 877-683-2065

Fill out the ACH form and return it via email or fax: