Pet-Ag, Inc. Authorized Online Seller Application

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

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.

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

Fax Number

Entity Type

State of Incorporation

Year Incorporated

DUNS

EIN

Resale Certificate Number

Resell Certificate Issuing State

Seller Category

Seller Type

Seller Type DA distribution

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?

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

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

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?

Are there any pending lawsuits involving the Applicant?

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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