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.
Registration Step 2:
Download, print, fill out, and return the KY Meds ACH Form via email to email@example.com or fax to 877-683-2065