PetShelf Customer Application

70 Morningside Dr, New York, NY 10022 | (610) 250-2099 | www.mypetshelf.com
CUSTOMER APPLICATION INSTRUCTIONS: Please answer ALL questions listed below. Federal Tax I.D. numbers are required information. If a question does not pertain to your company or you individually, please mark the answer 'N/A'. The customer has the obligation to notify PetShelf Distributors, LLC. in writing as to any changes of the information supplied herein.
BASIC INFORMATION
NAME OF COMPANY*
TRADING AS
WEBSITE URL
IS THE COMPANY TAX EXEMPT?*

YesNo
TAX EXEMPT CERTIFICATE ID
TAX EXEMPT STATE
EXPIRATION DATE

MonthDayYear
Date
TAX EXEMPT CERTIFICATE UPLOAD

Cancelof
CURRENT DISTRIBUTORS (list all below)

CONTACT INFORMATION
PRINCIPAL CONTACT
NAME*

APPLICANT FIRST NAMEAPPLICANT LAST NAME
APPLICANT EMAIL*
example@example.com
MARKETING EMAIL
PHONE NUMBER*
PHYSICAL ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code
BILLING CONTACT
Billing information same as Principal?*

YesNo
NAME

BILLING FIRST NAMEBILLING LAST NAME
BILLING PHONE NUMBER
BILLING ADDRESS

Street Address

Street Address Line 2

CityState

Zip Code
SHIPPING CONTACT
Shipping information same as Billing?*

YesNo
NAME

SHIPPING CONTACT FIRST NAMESHIPPING CONTACT LAST NAME
SHIPPING PHONE NUMBER
SHIPPING EMAIL
example@example.com
SHIPPING ADDRESS

Street Address

Street Address Line 2

CityState

Zip Code

Signature
COMPANY NAME*
SIGNATURE*

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DATE*

MonthDayYear
Date
All application information presented is warranted to be true. I/We hereby authorize PetShelf Distributors, LLC., its assigns and successors as their interest may appear to investigate my/our credit worthiness and financial responsibility. The undersigned represents that he/she is the owner/managing member/financially responsible party who unconditionally & personally guarantees payment of all invoices within the stated terms both for the corporation andindividually. All invoice(s) are due pursuant to the terms explicitlystated on the invoice(s) and in the event of default the undersigned agrees to pay all finance charges at the PetShelf prevailing rate until the balance is paid in full, costs of collection and/or reasonable attorney’s fees.Nonpayment or continued slow payment of invoices or finance charges will be cause, at the discretion of PetShelf, for the account’s suspension resulting in termination of ordering privileges. Suspension/termination of orderingprivileges will not in any way relieve the undersigned guarantor’s obligation to pay all accrued amounts due. PetShelf reserves the right to change the account’s terms & conditions at its sole discretion. In the event the business issold or legal ownership otherwise changes, the undersigned shall immediately inform PetShelf in writing and identify the successors contact information as well as all attorney’s information prior to the change officially taking effect.

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PetShelf Customer Application

BASIC INFORMATION

CONTACT INFORMATION

PRINCIPAL CONTACT

BILLING CONTACT

SHIPPING CONTACT

TRANSPORTATION AND SALES INFORMATION

TRANSPORTATION INFORMATION

SALES INFORMATION:

PRODUCTS AND SERVICES

Signature