Become A Dealer

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Owner Name*
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At present location since*
Date Format: MM slash DD slash YYYY
Billing Address*
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Is your shipping address the same as your billing address?*
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Additional Locations
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Applying for a credit line?*
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- Yes
Reference #1
Name*
Account #*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
If applicable, include extension.
Contact*
Fax*
If applicable, include extension.
Email*
Reference #2
Name*
Account #*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
If applicable, include extension.
Contact*
Fax*
If applicable, include extension.
Email*
Reference #3
Name*
Account #*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
If applicable, include extension.
Contact*
Fax*
If applicable, include extension.
Email*
Business Information
Duns Number*
Accounts Payable Contact*
First Last
Phone*
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Email*

Authorized Buyer*
First Name Last Name
I certify that (Name of Firm or Buyer) engaged in activities as a*
- Wholesaler
- Retailer
- Manufacturer
Email*
Address*
Street Address City State ZIP Code
Business License / Tax ID #

and is registered with the state of*
Sales Agreement*
- I certify the information is true and accurate.
The company listed in the above state within which your firm would deliver purchases to us and that any such purchases are for wholesale, resale, ingredients or components of a new product to be resold, leased, or rented in the normal course of business. We are in the business of wholesaling, manufacturing, leasing, renting Pet related products and equipment. I further certify that purchases from Hyper Pet would consist of Pet Products or related items and that if any property so purchased tax free is used or consumed by the firm as to make it subject to a Sales or Use Tax we will pay the tax due directly to the proper taxing authority when state law so provides or inform the seller for added tax billing. This certificate shall be a part of each order, which we may hereafter give to you, unless otherwise specified, and shall be valid until canceled by us in writing or revoked by the city or state. Under penalties of perjury, I swear or affirm that the information in this form is true and correct as to every material matter.
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Reference #1

Name	Phone	Address	City, State	Zip	Geo	Country

First Name	Last Name