Reseller Application -

Amber NaturalZ, Inc. Reseller Application

Are You Working With A Sales Rep?*

Grant

Janiel

Jenny

Terri

None

Amber Naturalz, INC is your source for Animal Health Products that are safe and effective. Our products are made from the finest ingredients available. The ingredients we provide are Non-GMO and are sent to a third-party laboratory for testing before released to the public. We sell to qualified resellers only. Please fill out the information below and submit it. Once we have received and evaluate the information we will contact you.

Forms of Payment: All orders placed will need to be payed by credit card before the order is shipped. We accept most major credit cards: Visa, MasterCard, Discover Card and American Express.

Working with an Amber NaturalZ, Inc Rep? (Place their Name below)

Name of Business:*

Primary Contact Name:*

Job Title:*

Email*

Website:

Phone*

Physical Storefront Address or Place of Business

Company Info:*

Street Address City State / Province / Region Postal / Zip Code

Type Of Business (CHECK ALL THAT APPLIES):*

Acupuncture

Breeder

Chiropractor

Consultant

Distributor

Drop Ship

Groomers

Health Food Store

Home Based Business

Kennel

Online Market Place (E-commerce)

Pet Store Franchise

Pet Supply Store

Rescue

Trainer

Veterinarian Clinic

Do you own a website?*

If YES, do you plan on listing our products on your website?

Do you use an online market place to sell products, if yes, which one[s] do you use?*

Amazon

eBay

Chewy.com

Walmart Online

None

Other[s]

If you do use an online market place to sell products, services or goods. What other business name[s] do you use to sell under? (If this does not apply to you simply type NONE)*

We provide a dealer agreement and a MAP policy to all qualified resellers. These practices and agreements are set inplace to protect the integrity of our products, customers and you the reseller. If any reseller is violating the dealer agreement and/or MAP policy, we will refuse all future purchases.

Please sign below acknowledging that you are a company official and that all information is correct. Please be advisedthat the information provided on this form will be used to evaluate your company’s ability to carry our products. It doesnot automatically qualify your company.

By providing us with your EIN or 501C3 number, you agree to our Terms & Conditions, and by typing your name this will act as your signature electronically and will become a legally binding form.

EIN or 501C3*

Upload Copy of 501C3 or EIN Business Document*

Name

First

Last

Middle

Date

We are NOT accepting Amazon Resellers.

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