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    Thank you for you interest in opening an account with us. Please fill out the short account application below.


    Practice Name
    Veterinarian's Name
    Mailing Address
    City  State  Zip 
    County 
    Shipping Address
    (if different from mailing) City  State  Zip 
    County 
    Phone Number
    Fax Number
    E-Mail Address
    Confirm E-Mail
    Purchasing Contact
    Type of Business: Corporation   Limited  LLC  Partnership  LLP   Individual

    Type of Practice: Small Animal     Equine     Mixed    Large Animal

    University    Shelter   Lab   Government   Other 

    Payment Preference: Credit Card     Electronic Funds Transfer    COD    Net 30 Days Open Billing
    Credit Card (no discounts apply)
    EFT (eligible for 2% prompt pay discount)
    COD (automatic 3% prompt pay discount)
    Net 30 Days Open Billing (eligible for 3% prompt pay discount) - May require a credit review.


    How did you hear about us? Friend/Colleague    Who?   
    Representative Call/Visit
    Web Search
    Website
    Trade Show/Conference
    Other    Please Describe:   

    Once we receive your information please expect the following:
    • A customer service representative will call to verify the application
    • We will also fax you a copy of the information we received for the necessary signatures. Once signed, it can be faxed back to us along with copies of the responsible veterinarian's State Veterinary License and Federal DEA License if you intend to purchase controlled substances.