Order Forms Request Screen

Important: You are using a web browser that either does not support Javascript, or you have Javascript turned off in your browser's properties.

This application is much easier to navigate if you have javascript available. Please download a javascript enabled browser, or turn javascript on in your browser.

To turn on Javascript, do the following:

Mozilla Firefox Select Tools->Options from the pulldown menu. Then select Web Features on the left, and select the Enable JavaScript checkbox.
Netscape/Mozilla: Select Edit->Preferences from the pulldown menu. Them select the Advanced folder, then select Scripts+Plugins. In the window to the right, set the "Enable Javascript for: Navigator checkbox.
Internet Explorer: Select the Tools->Internet Options from the pulldown menu. Then, select the Security tab. If it acceptable policy at your place of business, set the Security Level to Medium or lower.

Available Javascript enabled browsers are:

Netscape: Download
Mozilla: Download
Internet Explorer: Download

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.

DEA Number (Required - Not Case Sensitive)

Last Name or Business Name (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

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

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