Universal Drugstore which includes its officers, directors, affiliates, representatives, agents, contractors and sub-contractors (collectively, "Universal Drugstore") is an international prescription referral service committed to helping ensure that I, the undersigned patient ("I" or "Me"), am able to obtain medication, products and /or services ("Product") from licensed pharmacies. This Patient Authorization Agreement ("Agreement") shall govern all sales of Product facilitated by Universal Drugstore between me and any of Universal Drugstore's authorized pharmacies located in Canada, the United Kingdom, India, Mauritius, Turkey, Vanuatu, USA, and elsewhere (collectively, the "Pharmacy"). I acknowledge and agree as follows:
I HAVE READ AND UNDERSTAND THE FORGOING TERMS AND I AGREE THAT THEY SHALL BE BINDING UPON ME AND MY HEIRS, ASSIGNS, SUCCESSORS AND PERSONAL REPRESENTATIVES.
"I am the parent/legal guardian/power of attorney for the customer disclosed herein, am over the age of majority, and have full authority to sign for and provide the above representations to Universal Drugstore on the customer's behalf."