EssentialPetProducts.

com
1133 Bal Harbor Blvd. Suite 1125
Punta Gorda, Florida 33950
941-505-8220
Email: admin@essentialpetproducts.com

Authorized Retailer Application

Your Name:

Company Name: Year Established:

Address:

City: State: Zip Code:

Home Phone: Business Phone:

Fax: Email:

Where will you be selling our products: □ Internet / □ Retail Store / □ Other
If you checked “Internet” above, you MUST provide the FULL URL’s where you will sell our products.

Website URL:

eBay User ID AND Store URL:

Amazon Store URL:

Any Other User ID’s or URL’s:

Federal ID Number:

Sales Tax Exempt Number:

You must send us a copy of your sales tax certificate to be exempt from paying sales tax on orders shipping to
Florida.

References
Please provide at least three business or personal references.

Name Address Phone

I hereby certify that all information given in this application is true and correct to the best of my
knowledge.

Signature Date

All information you provide is strictly confidential. This information is for internal use of Essential Pet
Products, Inc. only and will not be divulged to any outside individuals or companies.