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To apply to become a dealer of Benefab® OR The Horse Holster®, please tell us about your organization.

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

Organization Name *

Billing Street Address *
Billing City *
Billing State *
Billing Postal Code *

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

Shipping Street Address
Shipping City
Shipping State
Shipping Postal Code

Phone Number *

Email *

Website

Facebook URL

Please describe your organization and its mission *

Dealer Type *

Retail (e-commerce / brick & mortar / mobile)Practitioner (veterinarian / therapist)

What Benefab® product lines are you looking to carry?

Canine

Equine

Human

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

Yes

Years in Business *

Business Structure *

LLCCorporationOther

Is your business independent? *

YesNo

Business License Number *

State Sales Tax ID Number *

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

Retail Store

Catalog

Internet

Mobile Store

Use this space to list any additional information you'd like for us to know about your organization. (Eg. Products offered)

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

When is a good day/time for a quick phone interview? *

*By clicking 'Apply Now', you are authorizing us to review your application to become a Licensed Dealer of our products. If your application is approved, and your dealer 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.