Get started by enrolling your office
Fill out the form below and click "submit" when you finish. When your enrollment is complete, call 866-264-2778 to submit your merchant ID and register the credit card terminal you will be using to process AVSOLA® Co-Pay Cards. All fields are required.
Office enrollment
Have questions about this form? Call the AVSOLA® Co-Pay Program at 866-264-2778 for assistance.