Located at the Link below
https://docs.google.com/spreadsheets/d/1XwHwUPufuJQHhmnotRz7MQ4vmZTFB7twHSgxzCC-jWk/edit#gid=0
 TERMINATION OF SERVICE FORM
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| Pharmacy Name | |||||
| Official Start Date | |||||
| Average weekly deliveries since start | |||||
| Average monthly deliveries since start | |||||
| Number of Drivers available | |||||
| Avg Distance for deliveries | |||||
| Avg Distance Pharmacy from driver home | |||||
| Payment History | |||||
| Total revenue since start | |||||
| Corporate? | |||||
| Notes: | |||||
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Last Contact:
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| Date Submitted: | |||||
| Approved By: | |||||
| Date Approved | |||||