Shamir RCPV Rewards Program

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Registration Info

If you have previously enrolled your practice for Shamir’s RCPV Rewards Program and received a letter detailing the “Registration Process” simply enter your Account Number and Phone Number to access your Account information.

Why am I required to Enroll?

W9 Form

Account Access

If you have already enrolled in Shamir’s RCPV program, please enter your account number and phone number to register for the RCPV site:
Account Number:		Phone Number:

Practice Enrollment Information

If you have not enrolled in Shamir’s RCPV program, please enter your information below. You will also need to fill out a W-9 and fax it to Shamir. You can print a W-9 after you submit your information below:

Practice Info:

Practice Name:

Mailing Address:

City: State: Zip:

Contact Info:

Last Name:

First Name: Title:

Phone:

Fax: Email:

Participating Labs:
Lab Name:
Lab Account #:

Reward Recipients:
Name:
% Share of Reward:

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