ROYAL PET SUPPLIES
NEW CUSTOMER APPLICATION FORM

IMPORTANT: For your application to be processed, you must fax a copy of your State Resale Certificate and two current invoices from a distributor you are currently dealing with for account verification to (954) 944-5169. Please indicate if you are new to the industry.

If you prefer to download, print and fax this form, you may do so by clicking here (Requires Adobe Acrobat Reader).
Please submit your application online or by fax but not both!

For help with form, please contact New Customer Requests

* Denotes required field

Store Information
* Account Name:   Alternate Name (DBA):
* Address 1: Address 2:
* City: * State:
* Zip: * Country:
* Email:

Trade References
* Reference 1:   * Reference 2:

Store Contact Information
Store Hours
Mon: Tue: Wed: Thu: Fri:
Buyer's Name: A/P Contact: Manager:
Store Phone & Ext: Mobile Phone: Fax:

How do you categorize your business?
* Check all that apply:
Retail Pet Shop Breeder Exporter Wholesaler Garden Center
Animal Hospital Internet Groomer Feed&Seed Aquarium Maintenance
Other (Please Describe):

Owner Information
* Business Type:  Corporation     Sole Proprietorship     Partnership  
* Name:
* Address 1: Address 2:
* City: * State: * Zip:
Phone: Mobile Phone:

Other Contact
Name:
Address 1: Address 2:
City: State: Zip:
Phone: Mobile Phone:

How did you hear about Royal Pet?
* Select 1:    Manufacturer     Internet    Print Ad     Store Owner  
Other (Please Describe):   
*Would you like to receive promotional material electronically?    Yes     No
* Internet Connection:    High Speed     DSL    Dial up    None

IMPORTANT: For your application to be processed, you must fax a copy of your State Resale Certificate and two current invoices from a distributor you are currently dealing with for account verification to (954) 944-5169. Please indicate if you are new to the industry.

* Denotes required field