OLD eCommerce VPRAC Licence Request

Order Request

Please enter your details and agency name below to start the order request.
Thank you for your interest in the Veeva PromoMats Review and Approval certification! There is a new version of this form here.
Requestor Name

First NameLast Name
Requestor Name (please provide your full name)*
Requestor Email*
example@example.com
Legal Entity Name - including company suffix *
Please include the legal company name
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is Certification a Customer Request?*

YesNo
Customer Name*
Payment Details
Payment Option:

Pay with Credit Card via Veeva Learning Certification Portal
The End User on this form will be added to the Veeva Learning platform. They will receive a welcome email and login details which are valid for 7 days.

Once the user has entered the system they will be able to purchase one license for the Vault PromoMats Review and Approval certification via credit card payment.

Please reach out to vprac@veeva.com with any additional questions.
User Information

Please provide the following information for the End User.
Learner Details*
Please take a moment to read through Veeva's Privacy Policy.
Should be Empty:

Order Request