Reseller Registration

CONTACT NAME*

COMPANY NAME*

EMAIL ADDRESS*

PHONE NUMBER*

WEBSITE ADDRESS

FAX NUMBER

PREFERRED METHOD OF PAYMENT

Credit Card
Check

IF OFFERED, WOULD YOU BE INTERESTED IN MARKETING AIDES TO USE IN YOUR STORE?

Yes
No

WHAT DO YOU SPECIALIZE IN? (check all that apply)

Supplements
Training
Natural Health Foods
Grooming
Boarding
Dog Wash
Other

TYPE OF BUSINESS (check all that apply)

Web Store/ Web Site
Physical Store
Distribution
Manufacturer's Rep

STREET ADDRESS

CITY/STATE/ZIP

RESELLER TAX ID

WHAT PRODUCTS INTEREST YOU? (check all that apply)

All
Joint Supplements
Vital Vities
In The Company Of Newfies
Monks Of New Skete Books & DVDs
Fire Hose Toys

WHY DO YOU THINK KATIE'S PET PRODUCTS FITS YOUR PRODUCT LINE?

HOW DID YOU HEAR ABOUT KATIE'S PET PRODUCTS?

Contact Information