CSA Order Forms Request

Order Forms Request Screen:

All requests for official order forms (DEA Form 222) can be made by registrants who are registered in Schedule I and/or II. Complete the form below in its entirety and click the Submit button.

(Required - Not Case Sensitive)

(Required - Not Case Sensitive)
As it appears on your registration. Example:
If "Smith, John Q MD" is on your registration, then enter: Smith
If "Smith's, Pharmacy" is on your registration, then enter: Smith's
If "Smith's Pharmacy" (no comma) is on your registration,
  then enter: Smith's Pharmacy

(Required so we may contact you if we cannot fulfill your request )

You will receive the maximum number of order forms allowed for your business activity.

Notice: A modification has been made to the “mailing address” portion of DEA form 222, also known as DEA order forms. Originally the mailing address consisted of five lines: first line for name; second line for additional company information; third and fourth lines for address; and the fifth line for city, state, and zip code. To implement mailing efficiencies with the U.S. Postal Service, the mailing address portion was changed to enable the USPS to view the bar code through the window of the envelope. To accomplish this, DEA had to remove the second line. It has been brought to our attention this action has caused some confusion and suppliers were questioning the validity of the DEA order form. To quickly remedy the situation, DEA has placed the second line (additional company information) right next to the first line (name). Unfortunately this action may result in truncated additional company information. We apologize for the misunderstanding this may have caused and appreciate your consideration.