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To apply to become a registered nonprofit of Benefab® OR Handy Holster®, please tell us about your organization.

Representative's First Name *
Representative's Last Name *

Organization Name *

Shipping Street Address *
Shipping City *
Shipping State *
Shipping Postal Code *

If your billing address is different from your shipping address, please specify below.

Billing Street Address
Billing City
Billing State
Billing Postal Code

Phone Number *

Email *

Website

Facebook URL

Please describe your organization and its mission *

Non-Profit Type *

501(c)(3) - Public charities or private foundations501(c)(5) - Labor, agricultural and horticultural organizations501(c)(19) - Veterans’ organizations501(d) - Religious associations

What Benefab® product lines are you looking to carry?

Canine

Equine

Human

We, also, own & distribute The Horse Holster. Are you interested in this product?

Yes

Years in Business *

Is your nonprofit independent? *

YesNo

EIN *

Tax ID Number *

What is your method of sale? Check all that apply.

Store

Catalog

Internet

Use this space to list any additional information you'd like for us to know about your organization.

What amount are you budgeting to spend annually on our products? *

Submitted by (First Name) *

Have you been working with someone at Benefab® in particular? *

Kat ChrysostomMet at a TradeshowNope, I'm by Myself! Other (i.e. Sales Rep)

If other was selected, please list an explanation or your Sales Rep Name

*By clicking 'Apply Now', you are authorizing us to review your application. If your application is approved, and your account is activated, you must submit your first order within sixty (60) days or you will be charged a $50.00 one-time administration fee for your account setup. This fee will be charged to your credit card on file. If you place an order within sixty (60) days of account setup, this fee is waived.