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To request access to our online catalog, please fill out this form or call 1-800-366-9953,
Monday through Friday, 8:30 a.m. - 4:30 p.m. (Eastern Time).
Our staff will be happy to assist qualified buyers.

Customer Information Fact Sheet
Firm's Name:
Trade Name:
Street Address:
City:
State:
Zip Code:
Country:
Date Business Started:
Contact Name:
Federal ID#:
Type of Owner:Sole Proprietor
Incorporated
Partnership
LLC
Customer Phone Number:
Customer Fax Number:
Customer E-mail Address:
Customer Website:
How did you hear about us? Web/Search Engine
Trade Show
Printed Ad/Post Card/Magazine
Another Pet Store
Other Source Not Listed

References:
Bank Name:
Bank Address:
Contact Name and Phone Number:
Trade Reference 1
Name:
Contact:
Fax:
Phone:
Trade Reference 2
Name:
Contact:
Fax:
Phone:
Trade Reference 3
Name:
Contact
Fax:
Phone:
Trade Reference 4
Name:
Contact:
Fax:
Phone:
Comments:
I hereby authorize the release of this information for the purposes of establishing a business relationship with Wyld’s Wingdom.
Name:
Title:
Date:

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Wyld's Wingdom, Inc.

(757) 858-8090