MY PET HAVEN DROP SHIPPING APPLICATION

Thank you for your interest in doing business with us!


All fields are required. Print and fill out the following form in it's entirety, sign and date and mail it to:

My Pet Haven ATTN: Accounts Division
PO Box 56
Rice Lake, WI 54868

OR if you prefer - you may print, fill out, and scan this form and send it to us via email at sales@mypethaven.com

 

PLEASE PRINT CLEARLY:

 

Your Company Name:

_______________________________________________________________


Your Full Name:

_______________________________________________________________

Your Email Address (double check for accuracy):

_______________________________________________________________


Your Business Address:

_______________________________________________________________


City, State and Zip Code:

_______________________________________________________________


Business Phone Number:__________________________________________

Is there another number where you can be reached? ___________________


Business URL:

_______________________________________________________________


How long have you been in business?

________ Yrs.   or    ________ Mos.   or    _________ Days



Your Resale License Number or Social Security Number for Tax reasons:

_______________________________________________________________

 

Do you plan on shipping acceptable items overseas? (note the rules page for full information) If so, please provide us with the following information:

Name on Credit Card (If different from above):

_____________________________________________________

Address where you receive your statements (If different from above):

_____________________________________________________

Type of Card - Circle One: Visa MasterCard Discover American Express

Credit Card Number: ____________________________________

Expiration Date: ______________   Security Code: ___________

 

I certify that the information I have given in this form is accurate. I also have read all company policies and I agree to abide by the rules set forth.

Printed Name:

_______________________________________________________________


Signature:

_______________________________________________________________


Today's Date: _______________________________