Vetraceuticals Rep Agreement

Required field

Applicant Info

Please provide the following information about the applicant(s)

first name:

last name:

email:

company name:

co-applicant first name:

co-applicant last name:

applicant SSN or Tax ID#:

co-applicant SSN:

cell phone:

alternative phone:

fax:

date of birth
(mm/dd/yy):

Mailing Info

Please provide the following information
about the rep:

mailing country:

mailing address 1:

mailing address 2:

mailing city:

mailing

state

mailing

zip

copy mailing info to shipping info
copy mailing info to billing info

Shipping Info

Please provide the following information
about the rep:

shipping country:

shipping address 1:

shipping address 2:

shipping city:

shipping state:

shipping zip:

copy shipping info to mailing info
copy shipping info to billing info

Billing Info

Please provide the following information
about the rep:

billing country:

name on card:

billing address 1:

billing address 2:

billing city:

billing state:

billing zip:

copy billing info to shipping info

Payment

required

Credit Card

Please fill in the rep's card info:

credit number:

credit expiration (mm/yy):

3-4 digit code: what is this?

Check

pay by check

Create a Password:

password:

confirm password:

Create a Hint:

password hint:

Optionally, you may upload a picture that will appear by the rep name:

perhaps a picture of the rep?

(10240KB max)
(gif, jpg, jpeg, png, tiff, tif)

Img max width:

Img max height:

Optionally, you may upload a picture for the left bar on the home page:

perhaps a picture of a pet?

(10240KB max)
(gif, jpg, jpeg, png, tiff, tif)

Img max width:

Img max height:

Web Information

Please fill in the new rep's webalias:

(this is the portion of the address after "myvetra.com/")

(myvetra.com/webalias)

web alias:
*

web name:
*

phone displayed on site:

Custom Info

You may provide custom text

web text 1:

This text appears on the left of the home page

web text 2:

This text appears on the top of each page

Rep Category

Pet professional - Pet professionals are anyone who owns their own pet business, such as groomer, dog walker, sitter, trainer, etc. Pet professionals must provide the corporate office with a copy of a valid business license. No registration fee or quarterly fees are charged the first year. However, all fees ($25 annual and $15 quarterly) will be due the second (on the reps anniversary date) and each subsequent year.

Fundraiser - Fundraisers are any organization that raises funds for a non-profit entity. Fundraisers must provide proof of their charitable/non-profit status such as a copy of a valid 501(c) certificate. Non-Profit organizations never have to pay any fees, annual or quarterly.

Marketing Representative - A Marketing representative is any person who does not fall into one of the previous two categories, i.e. Pet Professional or Fundraiser. Marketing Representatives pay a $25 a year registration fee and $15 each quarter for websites and email addresses.

rep category:

Please send us a copy of the business license to:

Vetraceuticals
39685 Sierra Drive,
Three Rivers, CA 93271
fax: (559) 561-0801

Please send us proof of charitable/non-profit status to:

Vetraceuticals
39685 Sierra Drive,
Three Rivers, CA 93271
fax: (559) 561-0801

Fees

Marketing reps are charged $25 per year for membership, and $15 per quarter for website and email service.

Professional reps are charged nothing for the first year, then $25 per year for membership, and $15 per quarter for website and email service.

We offer the Vetraceuticals Representative business opportunity to non-profit organizations at no charge.

I agree to pay these fees

agree to terms:

I agree
I disagree