Distributor Application Distributor Name Date Distributor Address City State StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Contact Name /Title Email Address Phone Fax Website Address Number of Years in Business? Does your company warehouse stock? Does your company warehouse stock? Yes No Number of other locations: What product categories does your company sell? Other Addresses if applicable: Does your company have sales reps? Does your company have sales reps? Yes No How many inside?: How many outside?: Does your company mail a flyer or catalog? Does your company mail a flyer or catalog? Yes No How many pages? How many are mailed? How Often/Scheduled? How Often/Scheduled?noneWeeklyBi-WeeklyMonthlyQuarterlyYearly Percent of your company's sales in the Equine market? What percent of your sales are in the Veterinarian market? What percent of your sales are in the Pet Grooming market? Percent of your company's sales in the Kennels market? Percent of your company's sales in the Ranch & Farm market? What percentage of your company's sales are in other markets? Does your company have a Dunn & Bradstreet account number? Does your company have a Dunn & Bradstreet account number? Yes No Dunn & Bradstreet account number 1 + 2 = Submit