Company Name: 
Contact Email:      
Mailing Address:   
City, State & Zip: 
Phone Number:   
Cell Number:        
Person(s) Authorized to Place Orders:

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New Business? When will store open?
Store Hours: 

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Type of Business:
Saddles &Tack:   Clothing & Tack:    Manufacturer:   Feed:
If Other Please Describe:

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Please Fill out that apply:
Federal Tax Number:          
State Tax Number:             
Resale License Number:      
State Registration Number:
State Store Number:          
Other Number:                   

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Please list 3 Current Vendors:
Vendor 1:
Vendor 2:
Vendor 3:

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Preferred Payment Method:
Visa/Mastercard:    COD:    Net 30:   
If COD or NET 30 must request Credit Application:    

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Please Send Catalog: Yes  No 

Comments:
Comments Here

I have read and understand Shiloh Stables and Tack, Inc. Terms and Conditions ** Yes