Order Form

I'm interested in reselling Petlet products. I'm a...*
Company Name:*
Number of Years in Business:
Billing Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is shipping address the same as billing address?*
- Yes
- No
Shipping Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Type of Organization?*
Name of the Subsidiary:*
Phone:*
Fax:
Email:
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Website:
Corporate Contact Information:
Purchasing Agent Name:
First Last
Purchasing Agent Phone:
Purchasing Agent Email:
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Accounts Payable Contact:
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Accounts Payable Contact Phone:
Accounts Payable Contact Email:
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Controller/CFO Name:
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Controller/CFO Phone:
Controller/CFO Email:
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Trade References:
Company 1 Name:*
Company 1 Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company 1 Phone:*
Company 2 Name:*
Company 2 Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company 2 Phone:*
Company 3 Name:*
Company 3 Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company 3 Phone:*
Bank Relationship:
Bank Name:*
Bank Phone:*
Bank Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Bank Account Number*
Credit Line Requirement:
Estimated Monthly Purchases:*
Name of Individual Completing Application:*
First Last
Title:*
By clicking "submit" the applicant agrees that the provided information is accurate and true. In order to induce Petigree Enterprises, LLC to establish a line of credit based on this application, the applicant agrees to pay for all purchases in accordance with Petigree Enterprises, LLC terms of sale. In the event it becomes necessary for Petigree Enterprises, LLC to incur costs for collection agencies or attorney fees in order to collect this debt, applicant agrees to reimburse Petigree Enterprises, LLC for all costs. Applicant further agrees to pay any late charges assessed for past due invoices and authorizes Petigree Enterprises, LLC to verify credit information provided above by contacting the references listed.
Name
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Corporate Contact Information:

Trade References:

Bank Relationship: