Controlled Substance Ordering System (CSOS) Customer Agreement

We are pleased to offer you the opportunity to place your order for controlled drugs using our electronic software product, the e222 Controlled Substance Ordering System . The first step in signing up for CSOS is to apply for and obtain a CSOS digital certificate from the DEA. To apply for a certificate, go to the DEA’s website at www.deaecom.gov/applycert.html . You must have your CSOS digital certificate before you can sign-up for the CSOS software below.

Once you have your CSOS digital certificate, please fill out the form below. Complete the account information EXACTLY as it was completed when applying for your certificate. This information is CASE SENSITIVE and must be identical to the information contained within your CSOS digital certificate.

IMPORTANT! Customer is solely responsible for protecting the data that is created from using the CSOS software (“CSOS Data”) and must have a dependable backup solution in place from the first day of operation. H. D. Smith cannot provide or reconstruct this information for you. If the CSOS data becomes corrupted or inaccessible, you will be required to reload the software, and then restore the data to the new computer/hard drive from YOUR OWN BACKUPS. H. D. Smith DOES NOT have the necessary files to be able to do this for you and cannot recreate them from sales history files. To learn more about your obligation to maintain your CSOS data, please visit the DEA’s website at http://www.deaecom.gov/csosmain.html.

Sign-up Information
Generic text
Customer Name
Street Address Line1
Street Address Line2
City
State
Zip
Registrant's First Name
Registrant's Last Name
H.D.Smith Acct. #
DEA #
Buyer's First Name
Buyer's Last Name
eMail Address
Internet Access	Dial-upHigh Speed
I understand and acknowledge that it is solely my responsibility to perform and maintain adequate backups of the data that is stored and created by the CSOS software. H. D. Smith is not responsible for providing any mechanism, either hardware or software related, for performing the backup of this data. I also understand and acknowledge that, in the event of the loss of this data, H. D. Smith does not have the ability or resources to recreate the data stored on my computer. I agree to hold H. D. Smith harmless from any liability for lost data. I agree with the above. I have received my CSOS digital certificate from the DEA and verify that the information listed above is identical to the information contained within that certificate. (required to complete)