Pharmacy Owner Application

Contact Information

First Name *

Last Name *

Phone *

Email *

Pharmacy Website

Which best describes your pharmacy's ownership? *

Business Information

Pharmacy Name *

City/Town *

Province *

Years in Operation *

Number of Full-Time Employees *

Source of Business *

Type of Pharmacy *

Name of Your Pharmacy Computer System *

Last Fiscal Year (Completed Period)

Annual Revenue (Last Fiscal Year) (CAD) *

Average Gross Margin % (i.e. Retail Sales and Non-Retail Sales) (Last Fiscal Year) *

EBITDA (Last Fiscal Year) (CAD) *

Net Profit (Last Fiscal Year) (CAD) *

Free Cash Flow (CAD) (Last Fiscal Year) *

Annual Prescription Volume (Last Fiscal Year) *

Current Year-To-Date

Optional, but recommended (Helps us see growth trends before the fiscal year ends)

Current YTD Revenue (CAD) *

Current YTD EBITDA (CAD) *

Current YTD Net Profit (CAD) *

Current YTD Free Cash Flow (CAD) *

Current YTD Prescription Volume *

Ownership Goals

Current Owner Income (i.e. Take Home Pay) (Annual) *

Desired Owner Income Goal (i.e. Take Home Pay) (Annual) *

Primary Growth Goal for the Next 12 - 24 Months *