Reseller Application Form

Name of Firm or Corp.:__________________________________Date Estab. ____________

State or Federal I.D. Account Number:________________________________

Type of Business Structure:__Proprietorship_____Partnership____Corporation

Name of Principal:__________________________________ Title: __________________

Purchasing:Contact name : _____________________ Phone Ext ____ Best time: ________

Address: ____________________________________________________________

Phone:_(__)__________________ Fax#: _(___)______________________

Email: _______________________ URL: http://www.____________________________

Business Classification:

____ Retail Reseller____distributor___Mfgr. ____ Avairy

Banking Reference:(one needed even for COD)

1.______________________ ___________________________ /__________________
Bank AddressCity, State, ZipPhone/Fax

Name of Person to Contact:_________________Acct.# ________________

Trade References:( at lease one needed)

1. ___________________/ ________________________________/ __________________
Co.Name AddressCity, State, ZipPhone/Fax

Name of Person to Contact: _______________________ Dealer/Acct.# ______________

2. ____________________ / ____________________________ / ___________________
Co. Name AddressCity, State, ZipPhone/Fax

Name of Person to Contact: ________________________ Dealer/Acct.# ______________

**State tax resale ID # ________________________ State ___
Parrot Paradise accepts Credit card payments and ships UPS -FedX
COD shipments or terms only upon prior approval.

Fax TO: (810) 415-6063 attn: Tony Girgenti
All reseller status, pricing & terms subject to confirmation by Paradise Imports Inc.- Parrot Paradise division and is based upon quantity purchases. All pricing at Parrot Paradises' web site and on flyers is at wholesale. Further discounts on bulk purchases of feed, cages and accessories is reserved for stocking resellers. Closeouts and specials will be offered to resellers first, due to a limited supply. Please call in your orders with your assigned resellers ID# to 1-800-4-Parrot ( 472-7768) Thanks!