Membership Application - E-Commerce

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


 

Membership Application - E-Commerce
Please take the time to fill out the information below to allow for a prompt processing of your application.

Firm Name: *
Designated Representative *
Address: *
City: *
State: *
Zip Code: *
Country:
Phone:
Fax:
When did this firm begin conducting business? (month/year) *
Email: *
When did this firm begin conducting business in the pet industry?(month/year) *
Website
(Maximum characters: 100)
You have characters left.
Applicant firm is a (check one)
Incorporated in what state, and when?(MM/DD/YY)
Name of all Partners.
Please describe.
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.
Is this other firm a member of WPA?
Has Applicant ever been a member of WWPIA? *
If Applicant answered yes, was it under the same name? If so, when and where.
If it was under another name, state name and years.
Does Applicant make retail sales? *
Do you issue a catalog? (if so please send in a copy) *
Check current industry memberships Applicant currently holds.
Do you offer a full line of merchandize? *
Or do you specialize? *
If Applicant answered yes to specialization, what do you specialize in. (select all that applies by holding down the control key while selecting with the left mouse button.)
If Applicant selected other please explain
What geographical area do you serve? *
Is your warehouse seperate from any retail activity? *
Address of warehouse: *
Size of warehouse: *
Number of employees: *
Business hours: *
Number of outside sales people: *
Please select below the various services you offer. (you make multiple selections by holding down the control key while using the left mouse button.) *
Please check the type of accounts you supply.(you make multiple selections by holding down the control key while using the left mouse button.) *

Please attach a copy of your business license or other business document showing your company's legal business status. (i.e. a city business license.) *

Please provide a list, including the name, address and phone, of 25 active accounts. Include approximately how many accounts you service. *
Please provide a list, including name, address and phone, of 25 principle manufacturers who supply you with merchandize. *
Please provide bank references including account number, address, phone and contact. *

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 *

Clear Selection
Total Dues

Payment Information

Amount to Charge :
Payment Method:

  Yes, please notify me of upcoming WPA events.



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Your form submission WILL be encrypted using SSL to ensure your privacy.

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