Membership Application - Manufacturer Form

Please take the time to fill out the information below to allow for a prompt processing of your application.


 

Membership Application - Manufacturer Form

Please take the time to fill out the information below to allow for a prompt processing of your application.

Firm Name: *
Street Address: *
PO Box:
City: *
State / Providence: *
Zip Code / Postal Code *
Country:
Phone:
Fax:
Designated Representative *
Email:
Approximate number of years your firm has been conducting business in the pet industry? *
Applicant firm is a (check one)
Incorporated in what state?
Name of all Partners.
Please describe.
Website
Name of Officers:
President:
Vice President:
Secretary:
Treasurer:
Has Applicant any ownership connection or other affiliation (legal, business or familial) with any other firm in the pet industry? *
If Applicant answered yes provide explanation in the area below.
Has Applicant ever been a member of WPA? *
If Applicant answered yes, was it under the same name? If so, when and where.
Is this other firm a member of WPA?
If it was under another name, state name and years.
Do you issue a catalog? (if so please send in a copy)
Does Applicant make retail sales? *
Check current industry memberships Applicant currently holds.
Briefly describe the general nature of your business. *
How does your firm sell goods & services to the pet industry? Please check all applicable items and indicate the percentage of sales related to each item.
% of total sales:
% of total sales:
% of total sales:
Please describe:
% of total sales:
A copy of a shipping invoice with correlating bill of lading. *
List 3 Distributors or Chain Stores you supply 1.
2. *
3. *
What geographic area do you serve? *
Please attach a copy of your business license or other business document showing your company's legal business status. (city business license for example) *
Please attach a copy of your catalog or sales literature used in selling your products or services. *
Customer List *

We agree to abide by the By-laws of WPA and with all regularly adopted amendments thereto. We also agree to conscientiously conduct our personal relationship with the trade and in all matters pertaining to business in conformity with recognized standards of business practice. We declare all information contained in this Application and questionnaire to be true and accurate. Further, we understand that acceptance of this Application and membership in the Association is subject to approval of its Board of Directors and that we will be notified of the Board's action. By Applicant's acknowledgement below, Applicant consents to the dissemination of all information contained in or attached to this Application to members of the Association's Board of Directors in order that the Application may be processed notwithstanding the fact that some members of the Board may be competitors of the Applicant and Applicant herby releases the Association from any and all claims alleged to have occurred as a result of the release of information contained in this Application. Permission is given to contact all references given in this Application.

Dues *

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Total

Payment Information

Amount to Charge :
Payment Method:

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