Pet-Ag, Inc. Authorized Online Seller Application

Pet-Ag, Inc. Authorized Online Seller Application

This application is designated specifically for eCommerce sales approval. However, if you currently have a physical store location, or express interest in selling our products at your physical store location, please check the box below.

Do you have a physical store location? If so, please check the box.

How many locations do you own and operate?

Applicants Information

Applying Business Legal Business Name*

DBA/Trade Name(s):

Website(s) for Review*

Requested Websites: Please identify all websites or mobile applications through which you wish to sell Pet-Ag, Inc. products (one per line, exact spelling required). Example: www.ABCStoreName.com Example: Amazon.com / Storefront name “ABC Store”/ Merchant ID

Additional Website (If Applicable)

Please identify all websites or mobile applications through which you wish to sell Pet-Ag, Inc. products (one per line, exact spelling required). Example: www.ABCStoreName.com Example: Amazon.com / Storefront name “ABC Store”/ Merchant ID

Additional Website (If Applicable)

Primary Contact*

Primary Contact Title*

Secondary Contact

Secondary Contact Title

Brand Control/MAP Contact*

If you have an internal team or individual please list their full contact information, including email addresses, or put N/A in the field

Business Physical Address*

Mailing Address, if different

Telephone*

Email*

Fax Number

Entity Type*

Select

State of Incorporation*

Year Incorporated*

DUNS*

EIN*

Resale Certificate Number

Resell Certificate Issuing State

Seller Category*

Select or enter value

Seller Type*

Select

Seller Type DA distribution*

Select

Name of Distributor*

List All Distribution Sources:

Do you store or intend to store your inventory of Pet-Ag, Inc. products at a location other than the Applicant Physical Address identified above?

Select or enter value

If yes, please provide the address for all locations where such inventory is stored or will be stored:

Do you use any third-party fulfillment service to store inventory or fulfill orders of Pet-Ag, Inc. products?

Select or enter value

If yes, please identify the name of the fulfillment service and describe the services provided:

Has the Applicant ever been a debtor in any bankruptcy, receivership, or other insolvency proceeding?

Select or enter value

Please explain these matters in detail:

Has any company in which any of the Applicant’s principals hold an ownership interest ever been a debtor in any bankruptcy, receivership, or other insolvency proceeding?

Select or enter value

Please explain these matters in detail:

Are there any pending lawsuits involving the Applicant?

Select or enter value

Please explain these matters in detail:

Applicant Agreement*

By submitting this Application and checking this box, Applicant acknowledges that authorization to sell on the Requested Websites is only granted once both Applicant and Pet-Ag, Inc. have executed the Pet-Ag, Inc. Authorized Online Seller Agreement, accessible below. https://petag.com/assets/files/Brand-Support/Pet-Ag-Inc.-Authorized-Online-Seller-Agreement.pdf

Applicant Agreement*

By checking this box, Applicant agrees that if Applicant is approved to sell Pet-Ag products on any or all of the Requested Websites, it will abide by the terms in the Pet-Ag, Inc. Authorized Online Seller Agreement with respect to any approved websites.

Applicant Agreement*

By checking this box, Applicant acknowledges that it has read all terms in the Pet-Ag, Inc. Authorized Online Seller Agreement.

Applicant Agreement*

Applicant indicates its agreement to the terms of the Pet-Ag, Inc. Authorized Online Seller Agreement by checking this box.

Applicant Signature*

Applicant indicates its agreement to the terms of the Pet-Ag, Inc. Authorized Online Seller Agreement by typing Applicant’s name here:

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