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Home
About Us
Dealer Application
Contact Us
1. Contact Information
First Name:
Last Name:
Phone:
Mobile/Cell:
.
Email:
2. Company Information
Company Name:
Phone:
Fax:
Email:
Address:
City:
Prov/State:
Country:
Postal/Zip:
Store Hours:
3. Business Information
Business type:
Corporation
Sole Proprietorship
Partnership
Company Website:
Years in Business:
Annual Sales Range:
Number of Employees:
Vendor#:
EIN #:
Notes:
4. Categorize your Business
Animal Hospital
Exporter
Groomer
Garden Centre
Aquarium Maintenance
Feed & Seed
Internet
Breeder
Wholesaler
Retail Pet Shop
Other (specify):
5. Trade References
*Reference 1:
*Reference 2:
6. How Did you hear about Royal Aquatic?
Search Engine
Link from Website
Friends
Radio / TV
Business Card
Internet
Other (specify):
7. Please Choose Your website login and Password
Username:
Password:
8. Consent
I AGREE
to receive Royal Aquatic's newsletters and emails containing news, updates and promotions regarding Royal Aquatic's products.You can withdraw your consent at any time.
I DO NOT AGREE
to receive Royal Aquatic's newsletters and emails containing news, updates and promotions regarding ROyal Aquatic's products.
